Basic Information
| Provider Information | |||||||||
| NPI: | 1972871929 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPENA MEDICAL ARTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 LONG RAPIDS RD | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497071315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893542142 | ||||||||
| FaxNumber: | 9893548600 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 LONG RAPIDS RD | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497071315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893542142 | ||||||||
| FaxNumber: | 9893548600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2011 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | TALASKI | ||||||||
| AuthorizedOfficialFirstName: | BONNIE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | RN, QI/QI MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9893584251 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALPENA MEDICAL ARTS, PC | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | AA036532 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9893542142 | 01 | MI | FM OFF-SITE NON-RHC SERVICES | OTHER |