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General NPI Number Information
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NPI Number | 1790894988
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Entity Type | Organization
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Legal Business Name | WEST BRANCH PULMONARY CLINIC PC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 780 N GAVORD RD
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City | STERLING
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State | MI
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Zip | 48659-9703
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Country | US
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Telephone | 989-654-2168
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Fax | 989-654-2825
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Provider Business Mailing Address
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Address Line | 780 N GAVORD RD
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City | STERLING
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State | MI
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Zip | 48659-9703
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Country | US
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Telephone | 989-654-2168
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Fax | 989-654-2825
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Authorized Official
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Title or Position | INSURANCE BILLER
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Name | MS. VICKI LYNN HERRICK
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Credential |
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Telephone | 810-564-9270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | TM0009037
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License Number State | MI
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