Healthcare Provider Details

I. General information

NPI: 1073055323
Provider Name (Legal Business Name): PREMIUM URGENT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 LANDER AVE
TURLOCK CA
95380-6240
US

IV. Provider business mailing address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

V. Phone/Fax

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

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: ERICK J GREEN
Title or Position: OWNER
Credential: MD
Phone: 559-797-4315