Provider Demographics
NPI:1184677866
Name:FAMILY HEALTH PC
Entity Type:Organization
Organization Name:FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-362-5132
Mailing Address - Street 1:19020 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-6701
Mailing Address - Country:US
Mailing Address - Phone:734-362-5100
Mailing Address - Fax:734-362-5147
Practice Address - Street 1:19020 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6701
Practice Address - Country:US
Practice Address - Phone:734-362-5100
Practice Address - Fax:734-362-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H21076OtherBCBSM
MICC3713OtherRR MEDICARE
MICC3713OtherRR MEDICARE
MICC3713OtherRR MEDICARE