MEDICARE: FOREST AREA HEALTH CENTER 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
1	261QP2300X	Primary Care Clinic/Center	4301046404	MI

General Provider Information

NPI Number	:	1255503249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST AREA HEALTH CENTER PC

Provider Business Mailing Address
First Line	:	113 MAIN ST
Second Line	:	PO BOX 221
City	:	FIFE LAKE
State	:	MI
Zip	:	49633-9062
Country	:	US
Telephone Number	:	231-879-4810
Fax Number	:	231-879-4916

Provider Business Practice Location Address
First Line	:	113 MAIN ST
Second Line	:
City	:	FIFE LAKE
State	:	MI
Zip	:	49633-9062
Country	:	US
Telephone Number	:	231-879-4810
Fax Number	:	231-879-4916

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. THABIT M BAHHUR
Credential	:	M.D.
Telephone Number	:	231-879-4810

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	10/09/2008

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