Provider Demographics
NPI:1144421959
Name:CAPAC MEDICAL CENTER P C
Entity Type:Organization
Organization Name:CAPAC MEDICAL CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MATICH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:810-395-4375
Mailing Address - Street 1:4316 CAPAC RD
Mailing Address - Street 2:
Mailing Address - City:MUSSEY
Mailing Address - State:MI
Mailing Address - Zip Code:48014-3108
Mailing Address - Country:US
Mailing Address - Phone:810-395-4375
Mailing Address - Fax:
Practice Address - Street 1:4316 CAPAC RD
Practice Address - Street 2:
Practice Address - City:MUSSEY
Practice Address - State:MI
Practice Address - Zip Code:48014-3108
Practice Address - Country:US
Practice Address - Phone:810-395-4375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPM406642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty