Provider Demographics
NPI:1972871929
Name:ALPENA MEDICAL ARTS, PC
Entity Type:Organization
Organization Name:ALPENA MEDICAL ARTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, QI/QI MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TALASKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:989-358-4251
Mailing Address - Street 1:211 LONG RAPIDS RD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1315
Mailing Address - Country:US
Mailing Address - Phone:989-354-2142
Mailing Address - Fax:989-354-8600
Practice Address - Street 1:211 LONG RAPIDS RD
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1315
Practice Address - Country:US
Practice Address - Phone:989-354-2142
Practice Address - Fax:989-354-8600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPENA MEDICAL ARTS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAA036532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9893542142OtherFM OFF-SITE NON-RHC SERVICES