Provider Demographics
NPI:1326199126
Name:FOREST AREA HEALTH CENTER, PC
Entity Type:Organization
Organization Name:FOREST AREA HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THABIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-879-4810
Mailing Address - Street 1:113 N. MAIN STREET
Mailing Address - Street 2:PO BOX 221
Mailing Address - City:FIFE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49633-0221
Mailing Address - Country:US
Mailing Address - Phone:231-879-4810
Mailing Address - Fax:231-879-4916
Practice Address - Street 1:113 N. MAIN STREET
Practice Address - Street 2:BOX 221
Practice Address - City:FIFE LAKE
Practice Address - State:MI
Practice Address - Zip Code:49633-0221
Practice Address - Country:US
Practice Address - Phone:231-879-4810
Practice Address - Fax:231-879-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID