Provider Demographics
NPI:1992981559
Name:ALPENA EXPRESS CARE AND FAMILY PRACTICE, PLC
Entity type:Organization
Organization Name:ALPENA EXPRESS CARE AND FAMILY PRACTICE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:DARGIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-356-2400
Mailing Address - Street 1:109 S 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1609
Mailing Address - Country:US
Mailing Address - Phone:989-356-2400
Mailing Address - Fax:989-354-2606
Practice Address - Street 1:109 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1609
Practice Address - Country:US
Practice Address - Phone:989-340-0555
Practice Address - Fax:989-340-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2019-05-17
Deactivation Date:2010-02-01
Deactivation Code:
Reactivation Date:2018-04-11
Provider Licenses
StateLicense IDTaxonomies
MI5101014566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty