Healthcare Provider Details

I. General information

NPI: 1386229896
Provider Name (Legal Business Name): PREMIUM URGENT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 09/06/2023
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 W SHAW AVE
CLOVIS CA
93612-3229
US

IV. Provider business mailing address

2021 HERNDON AVE STE 101
CLOVIS CA
93611-6316
US

V. Phone/Fax

Practice location:
  • Phone: 559-797-4315
  • Fax: 559-321-8730
Mailing address:
  • Phone: 559-797-4315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERICK JOSEPH GREEN
Title or Position: OWNER
Credential: MD
Phone: 504-236-1486