Provider Demographics
NPI:1780601740
Name:OAKLAND PRIMARY HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:OAKLAND PRIMARY HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-322-6747
Mailing Address - Street 1:46156 WOODWARD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-5033
Mailing Address - Country:US
Mailing Address - Phone:248-322-6747
Mailing Address - Fax:248-322-5787
Practice Address - Street 1:46156 WOODWARD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-5033
Practice Address - Country:US
Practice Address - Phone:248-322-6747
Practice Address - Fax:248-322-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104632453Medicaid
MI700F300860OtherBCBS MD/DO
MI500F399040OtherBCBS NURSE PRACTITIONER BILLING
MI231917Medicare Oscar/Certification
MIBT8238758OtherDEA NUMBER
MIF04404Medicare UPIN
MI142661OtherPROVIDER ID
MI4478540Medicaid
MIH85136Medicare UPIN