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General NPI Number Information
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NPI Number | 1295248508
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Entity Type | Organization
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Legal Business Name | PRESCOTT CLINIC P.C.
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 125 N WASHINGTON ST
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City | PRESCOTT
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State | MI
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Zip | 48756-5117
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Country | US
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Telephone | 989-873-3352
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Fax | 989-873-3949
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Provider Business Mailing Address
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Address Line | 1003 WOODSIDE AVE
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City | ESSEXVILLE
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State | MI
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Zip | 48732-1234
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Country | US
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Telephone | 989-892-7722
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Fax | 989-892-7455
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | WILLIAM E BERNER
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Credential |
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Telephone | 989-892-7722
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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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