| Michigan Masonic Home | |
|
1200 Wright Ave Alma MI 48801-1133 | |
| (989) 466-3864 | |
| (989) 463-8921 |
| Full Name | Michigan Masonic Home |
|---|---|
| Speciality | Family Medicine |
| Location | 1200 Wright Ave, Alma, Michigan |
| Authorized Official Name and Position | Michelle L Shaw (HEALTH INFORMATION SERVICES/CLINIC) |
| Authorized Official Contact | 9894663864 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan Masonic Home 1200 Wright Ave Alma MI 48801-1133 Ph: (989) 466-3864 | Michigan Masonic Home 1200 Wright Ave Alma MI 48801-1133 Ph: (989) 466-3864 |
| NPI Number | 1285465633 |
|---|---|
| Provider Enumeration Date | 08/08/2024 |
| Last Update Date | 08/08/2024 |
| Medicare PECOS PAC ID | 8628963311 |
|---|---|
| Medicare Enrollment ID | O20241122000882 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285465633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Prakash Sarvepalli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669411310 PECOS PAC ID: 6002897543 Enrollment ID: I20040601000976 |
| Provider Name | Ladawn M Logic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174812135 PECOS PAC ID: 3173791399 Enrollment ID: I20110714000105 |
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