=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821197922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL AMBULATORY SERVICES FOR HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1859 W GRAND RIVER AVE
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-1840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-349-4500
-----------------------------------------------------
Fax | 517-882-5822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27547
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48909-0547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-882-3318
-----------------------------------------------------
Fax | 517-882-5822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. EDWARD A. VARTANIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-882-3318
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------