Provider Demographics
NPI:1578009932
Name:FAMILY MEDICAL CENTER OF MICHIGAN, INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER OF MICHIGAN, INC
Other - Org Name:DEERFIELD SCHOOLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-850-6914
Mailing Address - Street 1:8765 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9583
Mailing Address - Country:US
Mailing Address - Phone:734-847-3802
Mailing Address - Fax:734-850-0520
Practice Address - Street 1:252 DEERFIELD ROAD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:MI
Practice Address - Zip Code:49238
Practice Address - Country:US
Practice Address - Phone:517-447-3015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)