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17445 Pine River Rd Leroy MI 49655 | |
(231) 829-3841 | |
(231) 829-9030 |
Full Name | |
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Speciality | Clinic/Center |
Location | 17445 Pine River Rd, Leroy, Michigan |
Authorized Official Name and Position | Julie Tatko (CEO) |
Authorized Official Contact | 2317452743 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1615 Michigan Ave Baldwin MI 49304-7984 Ph: (231) 745-2743 | 17445 Pine River Rd Leroy MI 49655 Ph: (231) 829-3841 |
NPI Number | 1700329521 |
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Provider Enumeration Date | 11/28/2016 |
Last Update Date | 11/12/2020 |
Medicare PECOS PAC ID | 1153215413 |
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Medicare Enrollment ID | O20170117000682 |
Identifier | Type | State | Issuer |
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1700329521 | NPI | - | NPPES |
0D36000 | Other | MI | BCBS GROUP ID |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |