Provider Demographics
NPI:1811992704
Name:ALPENA MEDICAL ARTS PC
Entity type:Organization
Organization Name:ALPENA MEDICAL ARTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GILIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-354-2142
Mailing Address - Street 1:211 LONG RAPIDS RD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1315
Mailing Address - Country:US
Mailing Address - Phone:989-354-2142
Mailing Address - Fax:989-354-8600
Practice Address - Street 1:211 LONG RAPIDS RD
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1315
Practice Address - Country:US
Practice Address - Phone:989-354-2142
Practice Address - Fax:989-354-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Z47603Medicare PIN
233900Medicare ID - Type Unspecified