Primary Care Clinic Of Jackson, P.c. | |
2218 Sugarloaf Ave Portage MI 49024-6771 | |
(269) 327-9700 | |
(269) 327-9701 |
Full Name | Primary Care Clinic Of Jackson, P.c. |
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Speciality | Internal Medicine |
Location | 2218 Sugarloaf Ave, Portage, Michigan |
Authorized Official Name and Position | Tahir A Alvi (PRESIDENT) |
Authorized Official Contact | 2693279700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Primary Care Clinic Of Jackson, P.c. Po Box 1599 Jackson MI 49204-1599 Ph: (269) 327-9700 | Primary Care Clinic Of Jackson, P.c. 2218 Sugarloaf Ave Portage MI 49024-6771 Ph: (269) 327-9700 |
NPI Number | 1821278193 |
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Provider Enumeration Date | 11/05/2007 |
Last Update Date | 07/20/2009 |
Medicare PECOS PAC ID | 6608909478 |
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Medicare Enrollment ID | O20100730000012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821278193 | NPI | - | NPPES |
3397804 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | TA065207 (Michigan) | Primary |
Provider Name | Tahir A Alvi |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1174509855 PECOS PAC ID: 6204881360 Enrollment ID: I20050322000440 |
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