=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235440124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEDFORD URGENT CARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2010
-----------------------------------------------------
Last Update Date | 06/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7980 LEWIS AVE
-----------------------------------------------------
City | TEMPERANCE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48182-9580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-726-6500
-----------------------------------------------------
Fax | 419-726-3775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7980 LEWIS AVE
-----------------------------------------------------
City | TEMPERANCE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48182-9580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-726-6500
-----------------------------------------------------
Fax | 419-726-3775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. ARSHAD A HUSAIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 419-726-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | 4301064164
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------