Healthcare Provider Details

I. General information

NPI: 1104296888
Provider Name (Legal Business Name): PREMIUM URGENT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BADGER FLAT RD SUITE A
LOS BANOS CA
93635-8600
US

IV. Provider business mailing address

2021 HERNDON AVE SUITE 101
CLOVIS CA
93611-6101
US

V. Phone/Fax

Practice location:
  • Phone: 209-826-8400
  • Fax: 209-710-8763
Mailing address:
  • Phone: 559-797-4315
  • Fax: 559-321-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERICK J GREEN
Title or Position: OWNER
Credential: M.D.
Phone: 559-797-4315