Provider Demographics
NPI:1124381793
Name:OAKLAND INTEGRATED HEALTHCARE NETWORK
Entity Type:Organization
Organization Name:OAKLAND INTEGRATED HEALTHCARE NETWORK
Other - Org Name:SUMMIT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-724-7438
Mailing Address - Street 1:P.O. BOX 430150
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343
Mailing Address - Country:US
Mailing Address - Phone:248-724-7600
Mailing Address - Fax:248-636-4025
Practice Address - Street 1:279 SUMMIT DRIVE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1601
Practice Address - Country:US
Practice Address - Phone:248-724-7600
Practice Address - Fax:248-636-4025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLAND INTEGRATED HEALTHCARE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-19
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231010Medicare Oscar/Certification