Basic Information
| Provider Information | |||||||||
| NPI: | 1437100674 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOWNSEND MEDICAL CENTER, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 HINCKLEY BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492036125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177840141 | ||||||||
| FaxNumber: | 5177843866 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 HINCKLEY BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492036125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177840141 | ||||||||
| FaxNumber: | 5177843866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | RAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5177840141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CC4901 | 01 | MI | RAILROAD MEDICARE | OTHER |