Provider Demographics
NPI:1356549679
Name:ASSOCIATES IN FAMILY MEDICINE, P.C.
Entity type:Organization
Organization Name:ASSOCIATES IN FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELL
Authorized Official - Middle Name:DENELL
Authorized Official - Last Name:HARPER-SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MS
Authorized Official - Phone:810-422-9235
Mailing Address - Street 1:G3169 BEECHER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3644
Mailing Address - Country:US
Mailing Address - Phone:810-422-9235
Mailing Address - Fax:810-422-9174
Practice Address - Street 1:G3169 BEECHER RD STE 102
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3644
Practice Address - Country:US
Practice Address - Phone:810-422-9235
Practice Address - Fax:810-422-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053372261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4764096Medicaid
MI4754198Medicaid
MIS22417Medicare UPIN
MI4754198Medicaid
MI4764096Medicaid
MIP21430002Medicare PIN
MIOP21430Medicare PIN