CENTER FOR FAMILY HEALTH

Provider Demographics

• NPI: 1700156999
• Name: CENTER FOR FAMILY HEALTH
• Entity Type: Organization
• Organization Name: CENTER FOR FAMILY HEALTH
• Other - Org Name: CENTER FOR FAMILY HEALTH NON FQHC SERVICES
• Other - Org Type: Other Name
• Authorized Official - Title/Position: PATIENT ACCOUNT MANAGER
• Authorized Official - Prefix: MS
• Authorized Official - First Name: MICHELLE
• Authorized Official - Middle Name: J
• Authorized Official - Last Name: MAYO
• Authorized Official - Phone: 517-748-5500
• Mailing Address - Street 1: 505 N JACKSON ST
• Mailing Address - City: JACKSON
• Mailing Address - State: MI
• Mailing Address - Zip Code: 49201-1266
• Mailing Address - Country: US
• Mailing Address - Phone: 517-748-5500
• Mailing Address - Fax: 517-780-9286
• Practice Address - Street 1: 505 N JACKSON ST
• Practice Address - City: JACKSON
• Practice Address - State: MI
• Practice Address - Zip Code: 49201-1266
• Practice Address - Country: US
• Practice Address - Phone: 517-748-5500
• Practice Address - Fax: 517-780-9286
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2012-01-05
• Last Update Date: 2012-01-05

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QC1500X	Ambulatory Health Care Facilities	Clinic/Center	Community Health	Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	1223G0001X	Dental Providers	Dentist	General Practice	Group - Multi-Specialty
No	124Q00000X	Dental Providers	Dental Hygienist		Group - Multi-Specialty
No	126800000X	Dental Providers	Dental Assistant		Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363LA2200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Adult Health	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Multi-Specialty
No	364SW0102X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Women's Health	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	0N81890	Other	MEDICARE PART B
	00D8005290	Other	BCBSM DENTAL GROUP PROV
	231865	Other	MEDICARE OSCAR/ CERTIFICATION
	0M12180	Other	MEDICARE ID TYPE UNSPECIFIED
	500C807070	Other	BCBSM GROUP ID
	700C810070	Other	BCBS GROUP