Provider Demographics
NPI:1952498685
Name:ROSE CITY FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:ROSE CITY FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-783-4664
Mailing Address - Street 1:300 W WASHINGTON
Mailing Address - Street 2:SUITE 150
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2113
Mailing Address - Country:US
Mailing Address - Phone:517-783-4664
Mailing Address - Fax:517-783-4698
Practice Address - Street 1:300 W WASHINGTON
Practice Address - Street 2:SUITE 150
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2113
Practice Address - Country:US
Practice Address - Phone:517-783-4664
Practice Address - Fax:517-783-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C86358Medicare PIN