Provider Demographics
NPI:1699008318
Name:VINCENT MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:VINCENT MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:989-753-7781
Mailing Address - Street 1:4046 HESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-4261
Mailing Address - Country:US
Mailing Address - Phone:989-753-7781
Mailing Address - Fax:989-753-1060
Practice Address - Street 1:4046 HESS AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-4261
Practice Address - Country:US
Practice Address - Phone:989-753-7781
Practice Address - Fax:989-753-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301023033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1032804Medicaid
MIB46106Medicare UPIN
MI0739110Medicare PIN