Provider Demographics
NPI:1154519171
Name:ORTHOPAEDIC CENTER OF MID-MICHIGAN P C
Entity type:Organization
Organization Name:ORTHOPAEDIC CENTER OF MID-MICHIGAN P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-793-1372
Mailing Address - Street 1:3875 BAY RD
Mailing Address - Street 2:STE 2S
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2417
Mailing Address - Country:US
Mailing Address - Phone:989-793-1372
Mailing Address - Fax:989-793-4518
Practice Address - Street 1:3875 BAY RD
Practice Address - Street 2:STE 2S
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2417
Practice Address - Country:US
Practice Address - Phone:989-793-1372
Practice Address - Fax:989-793-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055237174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICF8475OtherRAILROAD MEDICARE
MI0G31277OtherBCBSM PIN
MICF8475OtherRAILROAD MEDICARE
MI0N83960Medicare PIN