| Northridge Family Practice Llc | |
|
3190 Northridge Drive Hale MI 48739-9276 | |
| (989) 728-6000 | |
| (989) 728-6003 |
| Full Name | Northridge Family Practice Llc |
|---|---|
| Speciality | Internal Medicine - Clinical Cardiac Electrophysiology |
| Location | 3190 Northridge Drive, Hale, Michigan |
| Authorized Official Name and Position | Debra Provoast (OWNER) |
| Authorized Official Contact | 9897286000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northridge Family Practice Llc Po Box 279 Hale MI 48739-0279 Ph: (198) 972-8600 | Northridge Family Practice Llc 3190 Northridge Drive Hale MI 48739-9276 Ph: (989) 728-6000 |
| NPI Number | 1780803932 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 01/13/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780803932 | NPI | - | NPPES |
| MA061417 | Other | MI | MOHAMED ALI |
| DL074550 | Other | MI | DANIEL LEE |
| 104289418 | Medicaid | MI | |
| 114811801 | Medicaid | MI | |
| 080C510310 | Other | MI | BCBS GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301061417 (Michigan) | Secondary |
| 207RC0001X | Internal Medicine - Clinical Cardiac Electrophysiology | 5101011670 (Michigan) | Primary |
Hale Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 436 W Main St, Hale, MI 48739 Phone: 989-728-2800 Fax: 989-654-2348 | |
Mclaren Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 436 W Main St, Hale, MI 48739 Phone: 989-728-6516 Fax: 989-728-6519 | |
Mclaren Bay Region Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 436 W Main St, Hale, MI 48739 Phone: 989-728-6516 Fax: 989-728-6519 | |
Ascension St Joseph Hospital Hale Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3190 Northridge Rd, Hale, MI 48739 Phone: 989-728-6000 Fax: 989-728-6003 | |
Northridge Family Practice Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3190 Northridge Drive, Hale, MI 48739 Phone: 989-728-6000 Fax: 989-728-6003 | |
Thunder Bay Community Health Service, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 311 N Washington St Rm Tb1, Hale, MI 48739 Phone: 989-742-4583 Fax: 989-742-2183 |