Provider Demographics
NPI:1578958484
Name:ALPENA HEALTH MULTISPECIALTY CLINIC
Entity Type:Organization
Organization Name:ALPENA HEALTH MULTISPECIALTY CLINIC
Other - Org Name:ALPENA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ULYSSES
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-255-5400
Mailing Address - Street 1:1105 W CHISHOLM ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1105 W CHISHOLM ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1617
Practice Address - Country:US
Practice Address - Phone:989-255-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty