Provider Demographics
NPI:1629001235
Name:HEALTH FIRST MEDICAL CENTER PLC
Entity Type:Organization
Organization Name:HEALTH FIRST MEDICAL CENTER PLC
Other - Org Name:MY FAMILY DOCTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARSHAVARDHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRISHNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-891-1500
Mailing Address - Street 1:12100 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3531
Mailing Address - Country:US
Mailing Address - Phone:734-282-5502
Mailing Address - Fax:734-282-7106
Practice Address - Street 1:12100 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3531
Practice Address - Country:US
Practice Address - Phone:734-282-5502
Practice Address - Fax:734-282-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
MI4301070833261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-4942723Medicaid