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General NPI Number Information
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NPI Number | 1689697930
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Entity Type | Organization
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Legal Business Name | AUSABLE MEDICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 81 S. I-75 BUSINESS LOOP
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City | GRAYLING
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State | MI
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Zip | 49738-0393
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Country | US
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Telephone | 989-348-7400
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Fax | 888-821-5005
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Provider Business Mailing Address
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Address Line | PO BOX 393
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City | GRAYLING
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State | MI
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Zip | 49738-0393
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Country | US
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Telephone | 989-348-7400
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Fax | 888-821-5005
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GERALD W GERTISER II
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Credential | MSN, FNP-BC
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Telephone | 989-348-7400
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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 | LH010698
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601002890
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704216377
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704159028
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License Number State | MI
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