Provider Demographics
NPI:1407067051
Name:OWOSSO HEART INSTITUTE
Entity Type:Organization
Organization Name:OWOSSO HEART INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-729-9808
Mailing Address - Street 1:1350 E M 21 RM 100
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9047
Mailing Address - Country:US
Mailing Address - Phone:989-729-9808
Mailing Address - Fax:
Practice Address - Street 1:1350 E M 21 RM 100
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9047
Practice Address - Country:US
Practice Address - Phone:989-729-9808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI510102740207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P10890Medicaid
MIP00244059OtherRAILROAD MEDICARE
H48012Medicare UPIN
MI0P10890Medicaid