Provider Demographics
NPI:1588633788
Name:THE PREVENTIVE AND FAMILY CARE CENTER OF GENESEE COUNTY PC
Entity Type:Organization
Organization Name:THE PREVENTIVE AND FAMILY CARE CENTER OF GENESEE COUNTY PC
Other - Org Name:THE PREVENTIVE MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-233-5211
Mailing Address - Street 1:2284 S BALLENGER HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-4653
Mailing Address - Country:US
Mailing Address - Phone:810-233-5211
Mailing Address - Fax:810-233-5740
Practice Address - Street 1:2284 S BALLENGER HWY
Practice Address - Street 2:SUITE H
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-4653
Practice Address - Country:US
Practice Address - Phone:810-233-5211
Practice Address - Fax:810-233-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0B56255Medicare ID - Type Unspecified