Healthcare Provider Details

I. General information

NPI: 1932207909
Provider Name (Legal Business Name): FOUR SEASONS EMERGENCY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOBART ST
CADILLAC MI
49601-2331
US

IV. Provider business mailing address

PO BOX 58
CADILLAC MI
49601-0058
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-7245
  • Fax:
Mailing address:
  • Phone: 866-898-7139
  • Fax: 616-975-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SALLY ANN ANCEL
Title or Position: PRESIDENT
Credential: DO
Phone: 231-876-7245