Provider Demographics
NPI:1720125172
Name:PHYSICIANS VISTING HOME SERVICE
Entity Type:Organization
Organization Name:PHYSICIANS VISTING HOME SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIDOZIE
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:ONONUJU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-752-0706
Mailing Address - Street 1:4232 WINTERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8639
Mailing Address - Country:US
Mailing Address - Phone:989-752-0706
Mailing Address - Fax:989-752-0709
Practice Address - Street 1:2811 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3798
Practice Address - Country:US
Practice Address - Phone:989-752-0706
Practice Address - Fax:989-752-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080G312570OtherBLUE CROSS BLUE SHIELD
MI4998596Medicaid
MI080G312570OtherBLUE CROSS BLUE SHIELD
MI0P40910Medicare ID - Type Unspecified
MIH02738Medicare UPIN