Healthcare Provider Details

I. General information

NPI: 1801459185
Provider Name (Legal Business Name): SWEETWATER URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 E WRIGHT AVE
SHEPHERD MI
48883-9375
US

IV. Provider business mailing address

322 E WRIGHT AVE
SHEPHERD MI
48883-9375
US

V. Phone/Fax

Practice location:
  • Phone: 989-828-4614
  • Fax: 989-828-6853
Mailing address:
  • Phone: 989-828-4614
  • Fax: 989-828-6853

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: JONATHAN DANIELS
Title or Position: OWNER
Credential: PA-C
Phone: 989-828-4614