Provider Demographics
NPI:1588694442
Name:CADILLAC AFTER HOURS CLINIC PLLC
Entity type:Organization
Organization Name:CADILLAC AFTER HOURS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOORES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:231-775-8814
Mailing Address - Street 1:PO BOX 3140
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-3140
Mailing Address - Country:US
Mailing Address - Phone:616-459-0898
Mailing Address - Fax:616-459-6963
Practice Address - Street 1:440 COBB ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2542
Practice Address - Country:US
Practice Address - Phone:231-775-8814
Practice Address - Fax:231-775-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P17980Medicare ID - Type Unspecified
MI0P17980Medicare PIN