Provider Demographics
NPI:1417193616
Name:REXFORD PRIMARY CARE SERVICES,PLC
Entity Type:Organization
Organization Name:REXFORD PRIMARY CARE SERVICES,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:W
Authorized Official - Last Name:REXFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-638-1414
Mailing Address - Street 1:1361 FOREST PARK RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4638
Mailing Address - Country:US
Mailing Address - Phone:231-638-1414
Mailing Address - Fax:
Practice Address - Street 1:1361 FOREST PARK RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4638
Practice Address - Country:US
Practice Address - Phone:231-638-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty