Provider Demographics
NPI:1316997422
Name:HEALTH ONE MEDICAL CENTER
Entity type:Organization
Organization Name:HEALTH ONE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-381-5674
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-0339
Mailing Address - Country:US
Mailing Address - Phone:313-381-5674
Mailing Address - Fax:313-381-7224
Practice Address - Street 1:3022 DIX HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2591
Practice Address - Country:US
Practice Address - Phone:313-381-5674
Practice Address - Fax:313-381-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKS039208207R00000X
MIRC066966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty