Provider Demographics
NPI:1366488728
Name:EUCLID MEDICAL GROUP PC
Entity Type:Organization
Organization Name:EUCLID MEDICAL GROUP PC
Other - Org Name:REDIMED
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-892-7722
Mailing Address - Street 1:4175 N EUCLID AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2483
Mailing Address - Country:US
Mailing Address - Phone:989-667-0491
Mailing Address - Fax:989-667-0493
Practice Address - Street 1:4175 N EUCLID AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2483
Practice Address - Country:US
Practice Address - Phone:989-667-0491
Practice Address - Fax:989-667-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114601967Medicaid
CH5156OtherRAILROAD MEDICARE
MI115189275Medicaid
1007493OtherMCLAREN
MI0Z96017OtherBCBS
MI0Z96017OtherMEDICARE PTAN
MI112791147Medicaid
MI113512728Medicaid
MI700Z910470OtherBLUE CARE NETWORK
MI700Z910470OtherBLUE CARE NETWORK
MI113512728Medicaid
MI113512728Medicaid
MI115189275Medicaid