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NPI Code Detail

MEDICARE: ST. JOHNS INTERNAL MEDICINE

MEDICARE: ST. JOHNS INTERNAL MEDICINE
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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1699168708
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. JOHNS INTERNAL MEDICINE
Provider Business Mailing Address
First Line : 110 W HIGHAM ST
Second Line :
City : SAINT JOHNS
State : MI
Zip : 48879-1559
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 110 W HIGHAM ST
Second Line :
City : SAINT JOHNS
State : MI
Zip : 48879-1559
Country : US
Telephone Number : 989-224-0646
Fax Number :
Authorized Official
Title or Position : SUPERVISING PHYSICIAN
Name : DR. CHRISTOPHER BEAL
Credential : D.O.
Telephone Number : 989-224-0646
Provider Enumeration Date : 03/13/2015
Last Update Date : 03/13/2015

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Directions to “ST. JOHNS INTERNAL MEDICINE ” Practice Location

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