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1427074772

NPI Code Detail

MEDICARE: JOHN E VANCE D.O.

MEDICARE: JOHN E VANCE D.O.

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	208600000X	Surgery Physician	5101012733	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0989830003	OTHER	MI	BLUE CROSS MEDICARE ADVAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0987785	OTHER	MI	GENESEE HEALTH PLAN
3	5250193	OTHER	MI	BLUE CROSS
4	5250193	OTHER	MI	BLUE CARE NETWORK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	7292237	OTHER	MI	AETNA
7	C7107	OTHER	MI	MCARE
8	1006245	OTHER	MI	MCLAREN HEALTH PLAN
9	127401	OTHER	MI	PREFERRED CHOICE
10	382626202	OTHER	MI	CARE CHOICES
11	020046189	OTHER	MI	PALMETTO GBA - RR MEDICAR
12	H13883	OTHER	MI	HAP
13	0987785	OTHER	MI	HEALTH PLUS

General Provider Information

NPI Number	:	1427074772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E VANCE D.O.

Provider Business Mailing Address
First Line	:	8235 N HOLLY RD
Second Line	:	SUITE 1
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2441
Country	:	US
Telephone Number	:	810-694-9700
Fax Number	:	810-694-9940

Provider Business Practice Location Address
First Line	:	8235 N HOLLY RD
Second Line	:	SUITE 1
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2441
Country	:	US
Telephone Number	:	810-694-9700
Fax Number	:	810-694-9940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/01/2009

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Practice Location Address:

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Practice Fax:

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1104956895 — ANDREA JO GOETHALS D.O.
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Directions to “ JOHN E VANCE D.O.” Practice Location

Language	Start Address	Practice Location

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