Provider Demographics
NPI:1790821957
Name:ALPENA MEDICAL ARTS, P.C.
Entity Type:Organization
Organization Name:ALPENA MEDICAL ARTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIPAA PRIVACY OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TALASKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:989-354-2142
Mailing Address - Street 1:211 LONG RAPIDS RD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 LONG RAPIDS RD
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1315
Practice Address - Country:US
Practice Address - Phone:989-354-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAA036532261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M14000Medicare PIN