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General NPI Number Information
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NPI Number | 1821278193
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE CLINIC OF JACKSON, P.C.
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 2218 SUGARLOAF AVE
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City | PORTAGE
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State | MI
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Zip | 49024-6771
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Country | US
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Telephone | 269-327-9700
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Fax | 269-327-9701
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Provider Business Mailing Address
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Address Line | PO BOX 1599
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City | JACKSON
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State | MI
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Zip | 49204-1599
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Country | US
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Telephone | 269-327-9700
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Fax | 269-327-9701
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAHIR A ALVI
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Credential | M.D.
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Telephone | 269-327-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TA065207
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License Number State | MI
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