Provider Demographics
NPI:1124408943
Name:FAMILY CARE PRACTICE PLC
Entity Type:Organization
Organization Name:FAMILY CARE PRACTICE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-899-1680
Mailing Address - Street 1:1675 WATERTOWER PL
Mailing Address - Street 2:SUITE 700
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8043
Mailing Address - Country:US
Mailing Address - Phone:517-253-0539
Mailing Address - Fax:517-253-0536
Practice Address - Street 1:1675 WATERTOWER PL
Practice Address - Street 2:SUITE 700
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8043
Practice Address - Country:US
Practice Address - Phone:517-253-0539
Practice Address - Fax:517-253-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-06
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI207Q500000XOtherTAXONOMY
MI1902114424Medicaid
MI207Q500000XOtherTAXONOMY
MIMI8862Medicare PIN