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General NPI Number Information
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NPI Number | 1902999758
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Entity Type | Organization
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Legal Business Name | N E FAMILY PHYSICIANS & THERAPY SVC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 1044 CAMBRIA DR
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City | EAST LANSING
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State | MI
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Zip | 48823-2393
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Country | US
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Telephone | 616-821-6855
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Fax |
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Provider Business Mailing Address
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Address Line | 1044 CAMBRIA DR
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City | EAST LANSING
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State | MI
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Zip | 48823-2393
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Country | US
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Telephone | 616-821-6855
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Fax | 616-363-5180
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT ALLAN CARLSON
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Credential | DO
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Telephone | 616-821-6855
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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 | SC008093
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License Number State | MI
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