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General NPI Number Information
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NPI Number | 1083790026
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Entity Type | Organization
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Legal Business Name | SPRING STREET FAMILY PRACTICE
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1207 N SPRING ST
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City | GLADWIN
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State | MI
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Zip | 48624
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Country | US
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Telephone | 989-426-5553
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Fax |
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Provider Business Mailing Address
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Address Line | 801 JOE MANN BLVD STE P-6
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City | MIDLAND
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State | MI
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Zip | 48642-8900
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Country | US
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Telephone | 989-791-2455
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Fax | 989-791-1392
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Authorized Official
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Title or Position | OWNER
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Name | JANET FLYNN
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Credential | NP
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Telephone | 989-426-5590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4704126534
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License Number State | MI
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