Provider Demographics
NPI:1578894606
Name:AT HOME PHYSICIANS MANAGING CO
Entity Type:Organization
Organization Name:AT HOME PHYSICIANS MANAGING CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GADLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-897-7477
Mailing Address - Street 1:3771 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091
Mailing Address - Country:US
Mailing Address - Phone:877-897-7477
Mailing Address - Fax:877-755-1030
Practice Address - Street 1:3771 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091
Practice Address - Country:US
Practice Address - Phone:877-897-7477
Practice Address - Fax:877-755-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E033100OtherBCBS
MI700E033100OtherBCBS