Provider Demographics
NPI:1811177827
Name:PITTSBURG FAMILY HEALTHCARE, PC
Entity type:Organization
Organization Name:PITTSBURG FAMILY HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:989-729-9766
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-0519
Mailing Address - Country:US
Mailing Address - Phone:989-729-7779
Mailing Address - Fax:989-729-7313
Practice Address - Street 1:6980 S M 52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9515
Practice Address - Country:US
Practice Address - Phone:989-729-7779
Practice Address - Fax:989-729-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4472180Medicaid
MI4472180Medicaid
MI0N64180Medicare PIN