Provider Demographics
NPI:1114914298
Name:PHOENIX FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:PHOENIX FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:GM
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-790-3697
Mailing Address - Street 1:2429 TRAUTNER DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9596
Mailing Address - Country:US
Mailing Address - Phone:989-790-3697
Mailing Address - Fax:989-790-5035
Practice Address - Street 1:4215 FASHION SQUARE BLVD
Practice Address - Street 2:STE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1273
Practice Address - Country:US
Practice Address - Phone:989-790-3697
Practice Address - Fax:989-790-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON36920Medicare ID - Type Unspecified
ON36920Medicare UPIN