| Teen Center At Parkside | |
|
2400 4th St Jackson MI 49203-4573 | |
| (517) 788-6812 | |
| (517) 788-7722 |
| Full Name | Teen Center At Parkside |
|---|---|
| Speciality | Clinic/Center |
| Location | 2400 4th St, Jackson, Michigan |
| Authorized Official Name and Position | Michelle Mayo (PATIENT ACCOUNTS.MANAGER) |
| Authorized Official Contact | 5177485500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Teen Center At Parkside 505 N Jackson St Jackson MI 49201-1266 Ph: (517) 748-5500 | Teen Center At Parkside 2400 4th St Jackson MI 49203-4573 Ph: (517) 788-6812 |
| NPI Number | 1497825939 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 02/10/2022 |
| Certification Date | 02/10/2022 |
| Medicare PECOS PAC ID | 4587574421 |
|---|---|
| Medicare Enrollment ID | O20060119000254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497825939 | NPI | - | NPPES |
| 700C810070 | Other | MI | BCBSM GROUP PROVIDER |
| 500C807070 | Other | MI | BCBSM GROUP NUMBER |
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