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22721 Diamond Cove St Cassopolis MI 49031-9711 | |
(269) 445-9355 | |
(269) 445-9358 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 22721 Diamond Cove St, Cassopolis, Michigan |
Authorized Official Name and Position | Mary A Middleton (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2694453874 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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22721 Diamond Cove St Cassopolis MI 49031-9711 Ph: (269) 445-9355 | 22721 Diamond Cove St Cassopolis MI 49031-9711 Ph: (269) 445-9355 |
NPI Number | 1407266687 |
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Provider Enumeration Date | 04/28/2014 |
Last Update Date | 04/28/2014 |
Identifier | Type | State | Issuer |
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1407266687 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |