Provider Demographics
NPI:1053859017
Name:MASON FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:MASON FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-214-2239
Mailing Address - Street 1:839 S CEDAR ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-2063
Mailing Address - Country:US
Mailing Address - Phone:517-214-2239
Mailing Address - Fax:517-978-0018
Practice Address - Street 1:839 S CEDAR ST
Practice Address - Street 2:STE 100
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-2063
Practice Address - Country:US
Practice Address - Phone:517-214-2239
Practice Address - Fax:517-978-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N77190001Medicare PIN