Provider Demographics
NPI:1164044624
Name:VERNOR M
Entity Type:Organization
Organization Name:VERNOR M
Other - Org Name:VERNOR M, INC / VERNOR MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-841-0395
Mailing Address - Street 1:7649 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-1513
Mailing Address - Country:US
Mailing Address - Phone:313-841-0395
Mailing Address - Fax:
Practice Address - Street 1:7649 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-1513
Practice Address - Country:US
Practice Address - Phone:313-841-0395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty