Provider Demographics
NPI:1124111026
Name:FULL SPECTRUM FAMILY MEDICINE PC
Entity type:Organization
Organization Name:FULL SPECTRUM FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOLDING
Authorized Official - Last Name:PAGE-ECHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-333-3550
Mailing Address - Street 1:2025 ABBOT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8573
Mailing Address - Country:US
Mailing Address - Phone:517-333-3550
Mailing Address - Fax:517-333-8774
Practice Address - Street 1:2025 ABBOT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8573
Practice Address - Country:US
Practice Address - Phone:517-333-3550
Practice Address - Fax:517-333-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4151513Medicaid
MI4151522Medicaid
MIM91580003Medicare ID - Type Unspecified
MI4151513Medicaid
MI4151522Medicaid
MIF42325Medicare UPIN