Provider Demographics
NPI:1497793863
Name:MID-MICHIGAN FAMILY MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:MID-MICHIGAN FAMILY MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VAN ARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-627-3281
Mailing Address - Street 1:11615 HARTEL RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9165
Mailing Address - Country:US
Mailing Address - Phone:517-627-3281
Mailing Address - Fax:517-627-8722
Practice Address - Street 1:11615 HARTEL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-9165
Practice Address - Country:US
Practice Address - Phone:517-627-3281
Practice Address - Fax:517-627-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080B37601OtherBLUE CROSS BLUE SHIELD