Provider Demographics
NPI:1316092943
Name:BAYSIDE DOCS URGENT CARE PLC
Entity type:Organization
Organization Name:BAYSIDE DOCS URGENT CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMROG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-933-3283
Mailing Address - Street 1:401 MUNSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3041
Mailing Address - Country:US
Mailing Address - Phone:231-933-9150
Mailing Address - Fax:231-933-1553
Practice Address - Street 1:401 MUNSON AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3041
Practice Address - Country:US
Practice Address - Phone:231-933-9150
Practice Address - Fax:231-933-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056827261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP1143353OtherBCN
MI364465889OtherTRICARE
MI102803802OtherBCBS
MI4415649 TYPE 10Medicaid
MIC44521Medicare UPIN
MION36150Medicare ID - Type Unspecified