Provider Demographics
NPI:1740415082
Name:CITY MEDICAL
Entity Type:Organization
Organization Name:CITY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-283-2262
Mailing Address - Street 1:13636 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2432
Mailing Address - Country:US
Mailing Address - Phone:734-283-2262
Mailing Address - Fax:734-283-8121
Practice Address - Street 1:13636 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2432
Practice Address - Country:US
Practice Address - Phone:734-283-2262
Practice Address - Fax:734-283-8121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY MEDICAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009701207Q00000X
MI23D0998952291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23D0998952OtherCLIA CERTIFICATE OF COMPLIANCE