Healthcare Provider Details

I. General information

NPI: 1427062272
Provider Name (Legal Business Name): WHITE PINE FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 N MAIN
CEDAR SPRINGS MI
49319-9709
US

IV. Provider business mailing address

261 N MAIN
CEDAR SPRINGS MI
49319-9709
US

V. Phone/Fax

Practice location:
  • Phone: 616-696-2020
  • Fax: 616-696-4860
Mailing address:
  • Phone: 616-696-2020
  • Fax: 616-696-4860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number233808
License Number StateMI

VIII. Authorized Official

Name: ALISSA MARIE MATTHEWS
Title or Position: OWNER
Credential: PA-C
Phone: 616-696-2020