Healthcare Provider Details

I. General information

NPI: 1073094744
Provider Name (Legal Business Name): OWOSSO MEDICAL GROUP PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTH PARK DRIVE
OWOSSO MI
48867-4886
US

IV. Provider business mailing address

200 HEALTH PARK DR
OWOSSO MI
48867-1291
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-8666
  • Fax:
Mailing address:
  • Phone: 989-723-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MEGGIN SCHACK
Title or Position: MANAGER
Credential:
Phone: 989-723-8666