Organization Name: | OSCODA VA OUTPATIENT CLINIC |
NPI Number: | 1336243740 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALAN PAWLOW (CHIEF OF STAFF) |
Mailing Address: | 5671 N Skeel Ave Suite 4 Oscoda |
State: | MI US |
Postal Code: | 487501535 |
Phone Number: | 9897470026 |
Fax Number: | 9897470029 |
NPI Enumeration Date: | 09/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 4704165258 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |