Provider Demographics
NPI:1871677955
Name:SENIOR MEDICAL CORP. P.C.
Entity Type:Organization
Organization Name:SENIOR MEDICAL CORP. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-854-2999
Mailing Address - Street 1:6087 E FILMORE RD
Mailing Address - Street 2:
Mailing Address - City:WALKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49459-9344
Mailing Address - Country:US
Mailing Address - Phone:231-854-7655
Mailing Address - Fax:231-854-2998
Practice Address - Street 1:3944 S BRENLOR DR
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:MI
Practice Address - Zip Code:49421-9585
Practice Address - Country:US
Practice Address - Phone:231-854-2999
Practice Address - Fax:231-854-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRT007455207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4260509Medicaid
MIP00232094OtherRAIL ROAD MEDICARE
MIP00449750OtherRAIL ROAD MEDICARE
MIP00694735OtherRAIL ROAD MEDICARE
MIP00694735OtherRAIL ROAD MEDICARE
MI4260509Medicaid