Full Name | |
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Speciality | Clinic/Center |
Location | 5991 95th Ave, Evart, Michigan |
Authorized Official Name and Position | Amanda Knuth (CONTROLLER) |
Authorized Official Contact | 2313491616 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
100 Michigan St Ne # Mc845 Grand Rapids MI 49503-2560 Ph: (616) 486-6790 | 5991 95th Ave Evart MI 49631-9386 Ph: (231) 832-8700 |
NPI Number | 1669935615 |
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Provider Enumeration Date | 04/08/2019 |
Last Update Date | 08/22/2023 |
Medicare PECOS PAC ID | 1951215540 |
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Medicare Enrollment ID | O20190717000133 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669935615 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |