Provider Demographics
NPI:1821261116
Name:OAKLAND PRIMARY HEALTH SERVICES,INC
Entity Type:Organization
Organization Name:OAKLAND PRIMARY HEALTH SERVICES,INC
Other - Org Name:OPHS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHANEA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-322-6747
Mailing Address - Street 1:46 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2155
Mailing Address - Country:US
Mailing Address - Phone:248-322-6747
Mailing Address - Fax:248-322-5787
Practice Address - Street 1:46 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2155
Practice Address - Country:US
Practice Address - Phone:248-322-6747
Practice Address - Fax:248-322-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5220820Medicaid
MI4632453Medicaid
MI4632453Medicaid
MIBT6677287OtherDEA NUMBER
MIBT6677287OtherDEA NUMBER
MIH85136Medicare UPIN
MIH10577Medicare UPIN