Provider Demographics
NPI:1104855899
Name:SAGINAW VALLEY FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:SAGINAW VALLEY FAMILY MEDICINE, PC
Other - Org Name:VALLEY FAMILY MEDICINE, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MASSARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:999999999999-999-9999
Mailing Address - Street 1:INACTIVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:INACTIVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602
Practice Address - Country:US
Practice Address - Phone:999-999-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080240261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care