Healthcare Provider Details

I. General information

NPI: 1063482966
Provider Name (Legal Business Name): RIVER URGENT CARE & MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 WEST RD
TRENTON MI
48183-2225
US

IV. Provider business mailing address

3645 WEST RD
TRENTON MI
48183-2225
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-4900
  • Fax: 734-671-4949
Mailing address:
  • Phone: 734-671-4900
  • Fax: 734-671-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number4301052864
License Number StateMI

VIII. Authorized Official

Name: SAMER A NASRY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 734-671-4900