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General NPI Number Information
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NPI Number | 1265842918
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Entity Type | Organization
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Legal Business Name | PREVENTATIVE HEALTH SERVICES
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Dates
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Enumeration Date | 05/03/2014
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Last Update Date | 05/03/2014
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Provider Practice Location Address
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Address Line | G3317 BEECHER RD
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City | FLINT
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State | MI
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Zip | 48532-3615
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Country | US
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Telephone | 810-720-0800
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Fax |
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Provider Business Mailing Address
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Address Line | G3317 BEECHER RD
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City | FLINT
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State | MI
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Zip | 48532-3615
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Country | US
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Telephone | 810-720-0800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JONATHAN A OLDHAM
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Credential | RD
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Telephone | 269-325-4115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 86000710
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License Number State | MI
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