Healthcare Provider Details

I. General information

NPI: 1881622835
Provider Name (Legal Business Name): PRESCOTT CLINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WASHINGTON
PRESCOTT MI
48756
US

IV. Provider business mailing address

125 N WASHINGTON ST PO BOX 114
PRESCOTT MI
48756-5117
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 TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

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