Provider Demographics
NPI:1386737815
Name:MIDLAND FAMILY PHYSICIANS PC
Entity type:Organization
Organization Name:MIDLAND FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-839-9937
Mailing Address - Street 1:920 WEST WACKERLY STREET
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2700
Mailing Address - Country:US
Mailing Address - Phone:989-839-9937
Mailing Address - Fax:989-839-9220
Practice Address - Street 1:920 WEST WACKERLY STREET
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2700
Practice Address - Country:US
Practice Address - Phone:989-839-9937
Practice Address - Fax:989-839-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080E660120OtherBLUE CROSS BLUE SHIELD
MIOE660121082Medicare ID - Type Unspecified