Provider Demographics
NPI:1962590489
Name:AUSABLE PRIMARY CARE PC
Entity type:Organization
Organization Name:AUSABLE PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HANSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-348-1465
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:1200 W. NORTH DOWN RIVER RD
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-0422
Mailing Address - Country:US
Mailing Address - Phone:989-348-1465
Mailing Address - Fax:989-348-1798
Practice Address - Street 1:1200 W. NORTH DOWN RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:48738
Practice Address - Country:US
Practice Address - Phone:989-348-1465
Practice Address - Fax:989-348-1798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUSABLE PRIMARY CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010106998208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962590489OtherNPI
MIE90897Medicare UPIN
MI1962590489OtherNPI