Provider Demographics
NPI:1518118470
Name:PORT HURON FAMILY CARE PLLC
Entity Type:Organization
Organization Name:PORT HURON FAMILY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-982-1200
Mailing Address - Street 1:1979 HOLLAND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-8639
Mailing Address - Country:US
Mailing Address - Phone:810-982-1200
Mailing Address - Fax:810-982-6990
Practice Address - Street 1:1979 HOLLAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-8639
Practice Address - Country:US
Practice Address - Phone:810-982-1200
Practice Address - Fax:810-982-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJG075632261QP2300X
MIDK035998261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherCOMMERCIAL
MI=========OtherCOMMERCIAL
MIG37739Medicare UPIN