Provider Demographics
NPI:1306863204
Name:MIDLAND GENERAL PRACTICE PC
Entity Type:Organization
Organization Name:MIDLAND GENERAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HELM
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:989-832-8803
Mailing Address - Street 1:901 E INDIAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5397
Mailing Address - Country:US
Mailing Address - Phone:989-832-8803
Mailing Address - Fax:989-832-4134
Practice Address - Street 1:901 E INDIAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5397
Practice Address - Country:US
Practice Address - Phone:989-832-8803
Practice Address - Fax:989-832-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJV005853208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0155628580OtherBLUE CROSS BLUE SHIELD
MI2991184Medicaid
MI2991184Medicaid
MI5562858Medicare PIN