Provider Demographics
NPI:1174672968
Name:ELK RAPIDS PRIMARY CARE PLC
Entity Type:Organization
Organization Name:ELK RAPIDS PRIMARY CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-264-0399
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:ELK RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49629-0888
Mailing Address - Country:US
Mailing Address - Phone:231-264-0399
Mailing Address - Fax:231-264-0212
Practice Address - Street 1:115 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:ELK RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49629-5110
Practice Address - Country:US
Practice Address - Phone:231-264-0399
Practice Address - Fax:231-264-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISP014958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00890001Medicare PIN
MIP00890002Medicare PIN