Provider Demographics
NPI:1992270870
Name:SAGINAW VALLEY FAMILY CARE, PLLC
Entity type:Organization
Organization Name:SAGINAW VALLEY FAMILY CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:989-793-4250
Mailing Address - Street 1:4386 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-4067
Mailing Address - Country:US
Mailing Address - Phone:989-793-4250
Mailing Address - Fax:989-793-6880
Practice Address - Street 1:5200 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3713
Practice Address - Country:US
Practice Address - Phone:989-793-4250
Practice Address - Fax:989-793-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI17402000658OtherINDIVIDUAL NPI
MI1215128962OtherINDIVIDUAL NPI
MI1366926842OtherINDIVIDUAL NPI