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NPI Code Detail

MEDICARE: THUNDER BAY EMERGENCY PHYSICIANS PC

MEDICARE: THUNDER BAY EMERGENCY PHYSICIANS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician5010009914MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CI7552OTHERMIRAILROAD MEDICARE GROUP

General Provider Information

NPI Number : 1174526594
Entity Type Code : Organization
Provider Name (Legal Business Name) : THUNDER BAY EMERGENCY PHYSICIANS PC
Provider Business Mailing Address
First Line : PO BOX 2347
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49501-2347
Country : US
Telephone Number : 800-968-6866
Fax Number : 616-532-7230
Provider Business Practice Location Address
First Line : 1501 W CHISHOLM ST
Second Line :
City : ALPENA
State : MI
Zip : 49707-1401
Country : US
Telephone Number : 800-968-6866
Fax Number : 616-532-7230
Authorized Official
Title or Position : HEAD OF THE GROUP
Name : BEVIN CLAYTON
Credential : DO
Telephone Number : 800-968-6866
Provider Enumeration Date : 05/31/2005
Last Update Date : 01/14/2008

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Directions to “THUNDER BAY EMERGENCY PHYSICIANS PC ” Practice Location

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