Provider Demographics
NPI:1235303181
Name:MIDTOWN FAMILY PRACTICE
Entity Type:Organization
Organization Name:MIDTOWN FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAR
Authorized Official - Middle Name:PUGH
Authorized Official - Last Name:TALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-934-7750
Mailing Address - Street 1:129 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-4409
Mailing Address - Country:US
Mailing Address - Phone:269-927-3828
Mailing Address - Fax:269-927-3829
Practice Address - Street 1:129 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4409
Practice Address - Country:US
Practice Address - Phone:269-927-3828
Practice Address - Fax:269-927-3829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty