Provider Demographics
NPI:1699244533
Name:MEDCENTER URGENT CARE PLLC
Entity type:Organization
Organization Name:MEDCENTER URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAWAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-977-0200
Mailing Address - Street 1:33200 DEQUINDRE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5967
Mailing Address - Country:US
Mailing Address - Phone:586-977-0200
Mailing Address - Fax:
Practice Address - Street 1:33200 DEQUINDRE RD STE 200
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5967
Practice Address - Country:US
Practice Address - Phone:586-977-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty