Healthcare Provider Details

I. General information

NPI: 1396831251
Provider Name (Legal Business Name): FALLS CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 4TH ST
CRYSTAL FALLS MI
49920-1503
US

IV. Provider business mailing address

211 S 4TH ST
CRYSTAL FALLS MI
49920-1503
US

V. Phone/Fax

Practice location:
  • Phone: 906-875-6681
  • Fax: 906-875-3090
Mailing address:
  • Phone: 906-875-6681
  • Fax: 906-875-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101007427
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301036114
License Number StateMI

VIII. Authorized Official

Name: MS. BEVERLY A. SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 906-875-6681