Provider Demographics
NPI:1346468725
Name:OBSTETRICS AND GYNECOLOGIC ASSOCIATES OF FLINT PC
Entity Type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGIC ASSOCIATES OF FLINT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-239-9444
Mailing Address - Street 1:2 HURLEY PLZ
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5903
Mailing Address - Country:US
Mailing Address - Phone:810-239-9444
Mailing Address - Fax:810-239-8729
Practice Address - Street 1:2 HURLEY PLZ
Practice Address - Street 2:SUITE 204
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5903
Practice Address - Country:US
Practice Address - Phone:810-239-9444
Practice Address - Fax:810-239-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJH059336207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B57613Medicare PIN