Provider Demographics
NPI:1386229896
Name:PREMIUM URGENT CARE, INC.
Entity type:Organization
Organization Name:PREMIUM URGENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-236-1486
Mailing Address - Street 1:2021 HERNDON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6316
Mailing Address - Country:US
Mailing Address - Phone:559-797-4315
Mailing Address - Fax:
Practice Address - Street 1:565 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3229
Practice Address - Country:US
Practice Address - Phone:559-797-4315
Practice Address - Fax:559-321-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center