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General NPI Number Information
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NPI Number | 1346787025
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Entity Type | Organization
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Legal Business Name | ASMC II, PLLC
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 20626 120TH AVE
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City | TUSTIN
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State | MI
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Zip | 49688-8220
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Country | US
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Telephone | 231-667-7950
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Fax |
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Provider Business Mailing Address
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Address Line | 20626 120TH AVE
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City | TUSTIN
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State | MI
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Zip | 49688-8220
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Country | US
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Telephone | 231-667-7950
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRICIA ANN MCGILLS
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Credential | PA
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Telephone | 231-667-7950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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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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