Provider Demographics
NPI:1528643723
Name:JACKSON URGENT CARE PLLC
Entity type:Organization
Organization Name:JACKSON URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:H
Authorized Official - Last Name:DABAJA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, PHD
Authorized Official - Phone:517-888-6348
Mailing Address - Street 1:1407 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3517
Mailing Address - Country:US
Mailing Address - Phone:517-888-6348
Mailing Address - Fax:
Practice Address - Street 1:1407 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3517
Practice Address - Country:US
Practice Address - Phone:313-377-5758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty