Provider Demographics
NPI:1144390675
Name:CENTER FOR FAMILY HEALTH
Entity Type:Organization
Organization Name:CENTER FOR FAMILY HEALTH
Other - Org Name:CENTER FOR FAMILY HEALTH ROSE CITY OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT ACCOUNT SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-784-3950
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-0548
Mailing Address - Country:US
Mailing Address - Phone:517-784-3950
Mailing Address - Fax:517-783-2728
Practice Address - Street 1:300 W WASHINGTON AVE
Practice Address - Street 2:SUITE 060
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2180
Practice Address - Country:US
Practice Address - Phone:517-787-5970
Practice Address - Fax:517-787-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X, 1223G0001X, 124Q00000X, 207Q00000X, 207R00000X, 363AM0700X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500C807070OtherBCBSM GROUP PROVIDER
MI700C810070OtherBLUE CROSS BLUE SHIELD
MI0M12180Medicare ID - Type UnspecifiedMEDICARE PART B NUMBER
MI700C810070OtherBLUE CROSS BLUE SHIELD
MI231866Medicare Oscar/Certification