Basic Information
| Provider Information | |||||||||
| NPI: | 1417057670 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MED STOP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 WEST COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490153028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699654500 | ||||||||
| FaxNumber: | 2699651150 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 WEST COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490153028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699654500 | ||||||||
| FaxNumber: | 2699651150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | GLENN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2699654500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.