Provider Demographics
NPI:1821197922
Name:MEDICAL AMBULATORY SERVICES FOR HEALTH PC
Entity Type:Organization
Organization Name:MEDICAL AMBULATORY SERVICES FOR HEALTH PC
Other - Org Name:DELTA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARTANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-882-3318
Mailing Address - Street 1:PO BOX 27547
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-0547
Mailing Address - Country:US
Mailing Address - Phone:517-882-3318
Mailing Address - Fax:517-882-5822
Practice Address - Street 1:1859 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1840
Practice Address - Country:US
Practice Address - Phone:517-349-4500
Practice Address - Fax:517-882-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0959030004Medicare NSC
MI0C36065Medicare PIN