Provider Demographics
NPI:1992880165
Name:MIDLAND CENTER FOR ACCESSIBLE HEALTH CARE
Entity type:Organization
Organization Name:MIDLAND CENTER FOR ACCESSIBLE HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCANDLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-837-9740
Mailing Address - Street 1:1509 WASHINGTON ST
Mailing Address - Street 2:STE D
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-837-5841
Mailing Address - Fax:989-837-3672
Practice Address - Street 1:1509 WASHINGTON ST
Practice Address - Street 2:STE D
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-837-9740
Practice Address - Fax:989-837-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4674079Medicaid
MI4692371Medicaid
MI4692442Medicaid
MI4674060Medicaid
MI4673993Medicaid
MI4674023Medicaid
MI4674041Medicaid
MI4718093Medicaid
MI4718100Medicaid
MI4692353Medicaid
MI4674050Medicaid
MI4692415Medicaid
MI4718324Medicaid
MI4674014Medicaid
MI4674032Medicaid
MI4723834Medicaid
MI4837933Medicaid
MI4829815Medicaid