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General NPI Number Information
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NPI Number | 1114914298
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Entity Type | Organization
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Legal Business Name | PHOENIX FAMILY PHYSICIANS PC
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 4215 FASHION SQUARE BLVD STE 1
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City | SAGINAW
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State | MI
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Zip | 48603-1273
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Country | US
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Telephone | 989-790-3697
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Fax | 989-790-5035
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Provider Business Mailing Address
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Address Line | 2429 TRAUTNER DR
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City | SAGINAW
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State | MI
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Zip | 48604-9596
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Country | US
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Telephone | 989-790-3697
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Fax | 989-790-5035
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROLINE GM SCOTT
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Credential | MD
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Telephone | 989-790-3697
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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 |
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License Number State |
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