Provider Demographics
NPI:1043352784
Name:DOWNRIVER INTERNISTS,P.C.
Entity Type:Organization
Organization Name:DOWNRIVER INTERNISTS,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:734-318-2418
Mailing Address - Street 1:21801 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4213
Mailing Address - Country:US
Mailing Address - Phone:734-287-3830
Mailing Address - Fax:734-287-4626
Practice Address - Street 1:21801 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4213
Practice Address - Country:US
Practice Address - Phone:734-287-3830
Practice Address - Fax:737-287-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI041891207R00000X
MI001424213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H249580OtherBCBSM
MI4134414Medicaid
MI110H249580OtherBCBSM
MI6188590001Medicare NSC
MI0N20180Medicare PIN