Basic Information
| Provider Information | |||||||||
| NPI: | 1114598125 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY MEDICAL CENTER OF MICHIGAN, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8765 LEWIS AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPERANCE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481829300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348473802 | ||||||||
| FaxNumber: | 7348500520 | ||||||||
| Practice Location | |||||||||
| Address1: | 1933 S CUSTER RD RM 101 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481611828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342432410 | ||||||||
| FaxNumber: | 7346392552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2021 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | SHAELISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PATIENT ACCOUNTS ASSISTANT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7348473802 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.