Healthcare Provider Details

I. General information

NPI: 1295248508
Provider Name (Legal Business Name): PRESCOTT CLINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N WASHINGTON ST
PRESCOTT MI
48756-5117
US

IV. Provider business mailing address

1003 WOODSIDE AVE
ESSEXVILLE MI
48732-1234
US

V. Phone/Fax

Practice location:
  • Phone: 989-873-3352
  • Fax: 989-873-3949
Mailing address:
  • Phone: 989-892-7722
  • Fax: 989-892-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM E BERNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 989-892-7722