Provider Demographics
NPI:1558840587
Name:PRO-HEALTH MEDICAL MIDLAND INC
Entity type:Organization
Organization Name:PRO-HEALTH MEDICAL MIDLAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:810-240-0023
Mailing Address - Street 1:111 E WACKERLY ST STE D
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 E WACKERLY ST STE D
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-7043
Practice Address - Country:US
Practice Address - Phone:810-240-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care