Provider Demographics
NPI:1194949990
Name:MEDICS PC
Entity type:Organization
Organization Name:MEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:H
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIANS ASSISTANT
Authorized Official - Phone:231-937-6226
Mailing Address - Street 1:220 N ENSLEY
Mailing Address - Street 2:PO BOX 517
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329
Mailing Address - Country:US
Mailing Address - Phone:231-937-6226
Mailing Address - Fax:231-937-7107
Practice Address - Street 1:220 ENSLEY ST
Practice Address - Street 2:
Practice Address - City:HOWARD CITY
Practice Address - State:MI
Practice Address - Zip Code:49329-8656
Practice Address - Country:US
Practice Address - Phone:231-937-6226
Practice Address - Fax:231-937-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001291261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI70-0-E9-6344-0OtherBCBSM GROUP ID #
MI70-0-E9-6344-0OtherBCBSM GROUP ID #