| Plum Hollow Center | |
|
22200 W. Nine Mile Rd Southfield MI 48033-6008 | |
| (248) 724-7600 | |
| Not Available |
| Full Name | Plum Hollow Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 22200 W. Nine Mile Rd, Southfield, Michigan |
| Authorized Official Name and Position | Debra Brinson (CEO) |
| Authorized Official Contact | 2487247438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Plum Hollow Center P.o. Box 430150 Pontiac MI 48343 Ph: (248) 724-7600 | Plum Hollow Center 22200 W. Nine Mile Rd Southfield MI 48033-6008 Ph: (248) 724-7600 |
| NPI Number | 1083965065 |
|---|---|
| Provider Enumeration Date | 10/01/2012 |
| Last Update Date | 06/01/2016 |
| Medicare PECOS PAC ID | 9436313004 |
|---|---|
| Medicare Enrollment ID | O20160308002318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083965065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Michigan) | Primary |
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