Healthcare Provider Details

I. General information

NPI: 1164601290
Provider Name (Legal Business Name): FAMILY FIRST HEALTH CARE, YALE, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7470 BROCKWAY RD
BROCKWAY MI
48097-3458
US

IV. Provider business mailing address

7470 BROCKWAY RD
BROCKWAY MI
48097-3458
US

V. Phone/Fax

Practice location:
  • Phone: 810-387-9355
  • Fax: 810-387-9400
Mailing address:
  • Phone: 810-387-9355
  • Fax: 810-387-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013003
License Number StateMI

VIII. Authorized Official

Name: DR. SCOTT MCPHILIMY
Title or Position: OWNER
Credential: D.O.
Phone: 810-387-9355