Organization Name: | WHITE PINE FAMILY MEDICINE PLLC |
NPI Number: | 1427062272 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALISSA MARIE MATTHEWS (OWNER) |
Mailing Address: | 261 N Main Cedar Springs |
State: | MI US |
Postal Code: | 493199709 |
Phone Number: | 6166962020 |
Fax Number: | 6166964860 |
NPI Enumeration Date: | 07/28/2006 |
NPI Last Update Date: | 11/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 233808 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |