Provider Demographics
NPI:1336243740
Name:OSCODA VA OUTPATIENT CLINIC
Entity Type:Organization
Organization Name:OSCODA VA OUTPATIENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-497-2500
Mailing Address - Street 1:5671 N SKEEL AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-1535
Mailing Address - Country:US
Mailing Address - Phone:989-747-0026
Mailing Address - Fax:989-747-0029
Practice Address - Street 1:5671 N SKEEL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-1535
Practice Address - Country:US
Practice Address - Phone:989-747-0026
Practice Address - Fax:989-747-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704165258261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVAD000Medicare UPIN