Crystal Lake Clinic Pc | |
1806 E Parkdale Ave Ste 2 Manistee MI 49660-9364 | |
(231) 882-9661 | |
Not Available |
Full Name | Crystal Lake Clinic Pc |
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Speciality | Family Medicine |
Location | 1806 E Parkdale Ave Ste 2, Manistee, Michigan |
Authorized Official Name and Position | Richard Nielsen (PRESIDENT) |
Authorized Official Contact | 2318829661 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Crystal Lake Clinic Pc 6227 Frankfort Hwy Benzonia MI 49616-8632 Ph: (231) 882-9661 | Crystal Lake Clinic Pc 1806 E Parkdale Ave Ste 2 Manistee MI 49660-9364 Ph: (231) 882-9661 |
NPI Number | 1134491731 |
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Provider Enumeration Date | 01/30/2012 |
Last Update Date | 01/30/2012 |
Medicare PECOS PAC ID | 0648259010 |
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Medicare Enrollment ID | O20040802000634 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134491731 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Gerard Mahoney |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1659385219 PECOS PAC ID: 3274428909 Enrollment ID: I20040220000080 |
Provider Name | Carol King |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1629046297 PECOS PAC ID: 2466436928 Enrollment ID: I20040614001424 |
Provider Name | Maureen Reynolds Street |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1093716052 PECOS PAC ID: 1557327038 Enrollment ID: I20041207000122 |
Provider Name | Mark A Priest |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1720157688 PECOS PAC ID: 0042277840 Enrollment ID: I20041215000296 |
Provider Name | Michael F Carroll |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1346338324 PECOS PAC ID: 5092764399 Enrollment ID: I20050118000633 |
Provider Name | Douglas M Spence |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1790875649 PECOS PAC ID: 9436111051 Enrollment ID: I20050118000656 |
Provider Name | Ryan A Sullivan |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1174605653 PECOS PAC ID: 0547292294 Enrollment ID: I20050906000090 |
Provider Name | Glenn Griffiths |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1932199965 PECOS PAC ID: 3173601770 Enrollment ID: I20080423000145 |
Provider Name | Maxine A Lipon |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1598984387 PECOS PAC ID: 3779640453 Enrollment ID: I20090331000431 |
Provider Name | George B Ryckman |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1023032380 PECOS PAC ID: 2961481346 Enrollment ID: I20101007000224 |
Provider Name | Jennifer K Gilbert |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477820983 PECOS PAC ID: 5294984225 Enrollment ID: I20121005000432 |
Provider Name | Jacob Flynn |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1104114230 PECOS PAC ID: 7315162948 Enrollment ID: I20140715001549 |
Provider Name | Matthew R Jackson |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1588897896 PECOS PAC ID: 5597994087 Enrollment ID: I20140818002073 |
Provider Name | Anna Cox |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1568842052 PECOS PAC ID: 3678887601 Enrollment ID: I20150804004041 |
Provider Name | Danielle Koch |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275771370 PECOS PAC ID: 8022316777 Enrollment ID: I20170523002170 |
Provider Name | Nancy Dorman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750801940 PECOS PAC ID: 9234401613 Enrollment ID: I20170818002861 |
Provider Name | Becky Lynn Porter |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811400302 PECOS PAC ID: 5294091666 Enrollment ID: I20171117002502 |
Provider Name | Heather Morgan Sedgwick |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598251589 PECOS PAC ID: 1254680820 Enrollment ID: I20180815003546 |
Provider Name | Heidi Collins |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336606078 PECOS PAC ID: 5395086292 Enrollment ID: I20190402002038 |
Provider Name | Anna L Mapes |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053910703 PECOS PAC ID: 4082026331 Enrollment ID: I20201210002415 |
Provider Name | Ashley Marie Goss |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306432059 PECOS PAC ID: 3476969247 Enrollment ID: I20210303001793 |
Provider Name | Amanda M Smith |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1740773456 PECOS PAC ID: 8022412923 Enrollment ID: I20210813000583 |
Provider Name | William David James |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1851754865 PECOS PAC ID: 9739586694 Enrollment ID: I20210921001254 |
Provider Name | Amanda Deering |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164180642 PECOS PAC ID: 5698167336 Enrollment ID: I20220110001225 |
Provider Name | Denielle Bohland |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306507363 PECOS PAC ID: 8921492372 Enrollment ID: I20220228002632 |
Provider Name | Charone Sexton |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083344980 PECOS PAC ID: 0446631915 Enrollment ID: I20220714001413 |
Provider Name | David Kamp |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982326468 PECOS PAC ID: 6103292891 Enrollment ID: I20221020002759 |
Indigo Hospital Medicine - Manistee, Plc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1400 E Parkdale Ave, Manistee, MI 49660 Phone: 231-346-6807 | |
West Shore Medical Center Physician Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1293 E Parkdale Ave, Manistee, MI 49660 Phone: 231-398-1750 Fax: 231-398-1751 | |
Little River Band Of Ottawa Indians Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2608 Government Center Dr, Manistee, MI 49660 Phone: 231-723-8299 Fax: 231-398-9684 | |
Harmony Health Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 50 Filer St Ste 324, Manistee, MI 49660 Phone: 231-887-4129 Fax: 231-887-4324 | |
Manistee Family Health Care Plc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 Washington St, Manistee, MI 49660 Phone: 231-723-9190 Fax: 231-723-9191 | |
Northwest Michigan Health Services, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 148 W Parkdale Ave, Manistee, MI 49660 Phone: 231-947-0351 Fax: 231-947-7739 |