Healthcare Provider Details

I. General information

NPI: 1396331328
Provider Name (Legal Business Name): MERCY HEALTH URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PLAINFIELD AVE NE
GRAND RAPIDS MI
49505-3261
US

IV. Provider business mailing address

1200 EAST CAMPBELL RD SUITE 108 - LOCKBOX #676224
RICHARDSON TX
75081-2730
US

V. Phone/Fax

Practice location:
  • Phone: 616-410-7701
  • Fax:
Mailing address:
  • Phone: 225-239-7190
  • 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: TAMARA SAMSON
Title or Position: VP - REVENUE CYCLE
Credential:
Phone: 225-239-7190