Provider Demographics
NPI:1922397447
Name:FAMILY MEDICAL CENTER OF MICHIGAN, INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER OF MICHIGAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-850-6914
Mailing Address - Street 1:8765 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9583
Mailing Address - Country:US
Mailing Address - Phone:734-847-3802
Mailing Address - Fax:734-850-0520
Practice Address - Street 1:905 N MACOMB ST
Practice Address - Street 2:STE 3
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3076
Practice Address - Country:US
Practice Address - Phone:734-240-4851
Practice Address - Fax:734-240-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
02214OtherPARAMOUNT HEALTH CARE
02214OtherPARAMOUNT HEALTH CARE
MI0E86031Medicare PIN