Provider Demographics
NPI:1275009763
Name:POPHEALTHCARE MEDICAL SERVICES OF MI, PC
Entity Type:Organization
Organization Name:POPHEALTHCARE MEDICAL SERVICES OF MI, PC
Other - Org Name:ILLINOIS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:BOX
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-793-7050
Mailing Address - Street 1:113 SEABOARD LN STE 200B
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8282
Mailing Address - Country:US
Mailing Address - Phone:615-721-7020
Mailing Address - Fax:
Practice Address - Street 1:113 SEABOARD LN STE 200B
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8282
Practice Address - Country:US
Practice Address - Phone:615-721-7020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POPHEALTHCARE MEDICAL SERVICES OF MI, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-23
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty