Organization
WILLIAM BEAUMONT HOSPITAL
Active
Parent organization
BEAUMONT URGENT CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEAUMONT URGENT CARE
Authorized official
LEE ANN ODOM (PRESIDENT SHARED SERVICES)
(947) 522-3326
Entity
Organization
Contact information
Practice address
6900 ORCHARD LAKE RD STE 100, BEAUMONT URGENT CARE, WEST BLOOMFIELD, MI 48322-3424
(248) 855-4134
Mailing address
26901 BEAUMONT BLVD, COMPLIANCE, SOUTHFIELD, MI 48033-4716
(947) 522-1964
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
MI
363A00000X
Physician Assistant
—
MI
363L00000X
Nurse Practitioner
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F359270
BCBSM
MI
01
—
0F362410
BCBSM
MI
01
—
0F399250
BCBSM
MI
Enumeration date
10/05/2016
Last updated
10/01/2021
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