Provider Demographics
NPI:1548562358
Name:ALYCE CARTER METOYER DO PC
Entity Type:Organization
Organization Name:ALYCE CARTER METOYER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYCE
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:METOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-224-0646
Mailing Address - Street 1:110 W HIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1559
Mailing Address - Country:US
Mailing Address - Phone:989-224-0646
Mailing Address - Fax:989-224-0929
Practice Address - Street 1:110 W HIGHAM ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1559
Practice Address - Country:US
Practice Address - Phone:989-224-0646
Practice Address - Fax:989-224-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015666207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4166Medicare PIN