Healthcare Provider Details

I. General information

NPI: 1275746091
Provider Name (Legal Business Name): BOSWORTH URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 W GRAND RIVER AVE
OKEMOS MI
48864-1840
US

IV. Provider business mailing address

1881 W GRAND RIVER AVE
OKEMOS MI
48864-1840
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-2100
  • Fax: 517-339-4620
Mailing address:
  • Phone: 517-339-2100
  • Fax: 517-339-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number5101014014
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA ROWE
Title or Position: CREDENTIALING
Credential:
Phone: 517-485-0001