Provider Demographics
NPI:1679902191
Name:PORTAGE PHYSICIAN PRACTICES INC.
Entity Type:Organization
Organization Name:PORTAGE PHYSICIAN PRACTICES INC.
Other - Org Name:PORTAGE HEALTH EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:921 W SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1921
Mailing Address - Country:US
Mailing Address - Phone:906-483-1777
Mailing Address - Fax:906-483-4616
Practice Address - Street 1:921 W SHARON AVE
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1921
Practice Address - Country:US
Practice Address - Phone:906-483-1777
Practice Address - Fax:906-483-4616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTAGE PHYSICIAN PRACTICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-05
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty