MEDICARE: OAKLAND PRIMARY HEALTH SERVICES, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	700F300860	OTHER	MI	BCBS MD/DO
3	500F399040	OTHER	MI	BCBS NURSE PRACTITIONER BILLING

General Provider Information

NPI Number	:	1780601740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKLAND PRIMARY HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	46156 WOODWARD AVE
Second Line	:	SUITE B
City	:	PONTIAC
State	:	MI
Zip	:	48342-5033
Country	:	US
Telephone Number	:	248-322-6747
Fax Number	:	248-322-5787

Provider Business Practice Location Address
First Line	:	46156 WOODWARD AVE
Second Line	:	SUITE B
City	:	PONTIAC
State	:	MI
Zip	:	48342-5033
Country	:	US
Telephone Number	:	248-322-6747
Fax Number	:	248-322-5787

Authorized Official
Title or Position	:	CFO
Name	:	MS. SHARON BERRY
Credential	:
Telephone Number	:	248-322-6747

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/28/2016

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