MEDICARE: CENTRAL MICHIGAN FAMILY PRACTICE

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	207Q00000X	Family Medicine Physician	5101014871	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1012731	OTHER	MI	MCLAREN HEALTH PLAN
2	0101842	OTHER	MI	PHP UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0853701105	OTHER	MI	BLUE CROSS BLUE SHIELD
5	610677100	OTHER		US DEPT OF LABOR

General Provider Information

NPI Number	:	1306866215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MICHIGAN FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	522 EAST MAIN STREET
Second Line	:
City	:	FARWELL
State	:	MI
Zip	:	48622
Country	:	US
Telephone Number	:	989-588-6153
Fax Number	:	989-588-6194

Provider Business Practice Location Address
First Line	:	522 EAST MAIN STREET
Second Line	:
City	:	FARWELL
State	:	MI
Zip	:	48622
Country	:	US
Telephone Number	:	989-588-6153
Fax Number	:	989-588-6194

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BROCK W HORSLEY
Credential	:	D.O
Telephone Number	:	989-588-6153

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	12/10/2010

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Directions to “CENTRAL MICHIGAN FAMILY PRACTICE ” Practice Location

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