| Jackson Urgent Care Pllc | |
|
1407 E Michigan Ave Jackson MI 49202-3517 | |
| (313) 377-5758 | |
| Not Available |
| Full Name | Jackson Urgent Care Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1407 E Michigan Ave, Jackson, Michigan |
| Authorized Official Name and Position | Ibrahim H Dabaja (DIRECTOR/OWNER) |
| Authorized Official Contact | 5178886348 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Urgent Care Pllc 1407 E Michigan Ave Jackson MI 49202-3517 Ph: (517) 888-6348 | Jackson Urgent Care Pllc 1407 E Michigan Ave Jackson MI 49202-3517 Ph: (313) 377-5758 |
| NPI Number | 1528643723 |
|---|---|
| Provider Enumeration Date | 03/10/2021 |
| Last Update Date | 12/19/2022 |
| Medicare PECOS PAC ID | 9234538901 |
|---|---|
| Medicare Enrollment ID | O20210528002120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528643723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Fadl A Chokr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003158171 PECOS PAC ID: 5294968350 Enrollment ID: I20160811001131 |
| Provider Name | Wael Hussein Dabaja |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174960371 PECOS PAC ID: 4688977119 Enrollment ID: I20170829003642 |
| Provider Name | Shelby R Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730812371 PECOS PAC ID: 6305229279 Enrollment ID: I20220810003154 |
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