Provider Demographics
NPI:1639277791
Name:FOREST AREA MEDICAL CENTERS PC
Entity Type:Organization
Organization Name:FOREST AREA MEDICAL CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:231-879-4810
Mailing Address - Street 1:113 MAIN STREET
Mailing Address - Street 2:P.O. BOX 30
Mailing Address - City:FIFE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49633
Mailing Address - Country:US
Mailing Address - Phone:231-879-4810
Mailing Address - Fax:231-879-4916
Practice Address - Street 1:113 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FIFE LAKE
Practice Address - State:MI
Practice Address - Zip Code:49633
Practice Address - Country:US
Practice Address - Phone:231-879-4810
Practice Address - Fax:231-879-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty