Provider Demographics
NPI:1245390814
Name:THE DOCTORS GROUP PC
Entity Type:Organization
Organization Name:THE DOCTORS GROUP PC
Other - Org Name:DBA ASSOCIATED MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEAGNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-969-6003
Mailing Address - Street 1:842 E. COLUMBIA AVENUE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015
Mailing Address - Country:US
Mailing Address - Phone:269-969-6003
Mailing Address - Fax:269-969-6051
Practice Address - Street 1:842 E. COLUMBIA AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015
Practice Address - Country:US
Practice Address - Phone:269-969-6003
Practice Address - Fax:269-969-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICJ8339OtherRAILROAD MEDICARE
MI0M99170Medicare PIN