Provider Demographics
NPI:1023006822
Name:MEDICAL ARTS CENTER
Entity Type:Organization
Organization Name:MEDICAL ARTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A I
Authorized Official - Last Name:MCGRAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-343-3107
Mailing Address - Street 1:335 E HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1127
Mailing Address - Country:US
Mailing Address - Phone:989-345-0807
Mailing Address - Fax:989-343-3107
Practice Address - Street 1:2463 S M 30
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9312
Practice Address - Country:US
Practice Address - Phone:989-345-0807
Practice Address - Fax:989-343-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030939207R00000X
MI4301037610207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1424045Medicaid
MI2603087Medicaid
MI0M92060Medicare ID - Type UnspecifiedGROUP ID
MIA75937Medicare UPIN
MI1424045Medicaid
MIM92060002Medicare ID - Type UnspecifiedFRANCO IDENTIFIER
MI2603087Medicaid