Provider Demographics
NPI:1073615092
Name:MARECK FAMILY AND GERIATRIC SERVICES, P.C.
Entity Type:Organization
Organization Name:MARECK FAMILY AND GERIATRIC SERVICES, P.C.
Other - Org Name:MARECK AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:POLLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-886-3707
Mailing Address - Street 1:3493 WOODS EDGE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6030
Mailing Address - Country:US
Mailing Address - Phone:517-886-3707
Mailing Address - Fax:517-349-1973
Practice Address - Street 1:3493 WOODS EDGE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6030
Practice Address - Country:US
Practice Address - Phone:517-886-3707
Practice Address - Fax:517-349-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800C313060OtherBLUE CROSS BLUE SHIELD
MI800C313060OtherBLUE CROSS BLUE SHIELD
OP40800Medicare PIN