Provider Demographics
NPI:1417057670
Name:MED STOP PC
Entity Type:Organization
Organization Name:MED STOP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-965-4500
Mailing Address - Street 1:680 WEST COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3028
Mailing Address - Country:US
Mailing Address - Phone:269-965-4500
Mailing Address - Fax:269-965-1150
Practice Address - Street 1:680 WEST COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3028
Practice Address - Country:US
Practice Address - Phone:269-965-4500
Practice Address - Fax:269-965-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M31600Medicare ID - Type Unspecified