CRYSTAL LAKE CLINIC, PC (NPI# 1306190475) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306190475 |
| Entity Type | Organization |
| Organization Name | CRYSTAL LAKE CLINIC, PC |
| Practice Address |
115 E 7th St Manton MI 49663-9429 |
| Mailing Address |
6227 Frankfort Hwy Benzonia MI 49616-8632 |
| Practice Telephone | 2318244100 |
| Practice Fax Number | 2318244108 |
| Mailing Telephone | 2318829661 |
| Mailing Fax Number | 2318829616 |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2012-10-29 |
| Authorized Official Name | RICHARD C NIELSEN (PRESIDENT) |
| Authorized Official Telephone | 2318829661 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679844849 | Crystal Lake Clinic, PC | Family Medicine | 5191 Rosewood Dr, Traverse City, MI 49685 | 2012-01-20 |
| Street Address |
115 E 7TH ST |
| City | MANTON |
| State | MI |
| Zip Code | 49663-9429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073660502 | Manton Medical Center PC | Clinic/Center | 115 E 7th St, Manton, MI 49663-9429 | 2007-01-05 |
| 1811400302 | Becky Lynn Porter | Nurse Practitioner | 115 E 7th St, Manton, MI 49663-9429 | 2017-11-07 |
| 1073947008 | Emily Lauren Moses | Physician Assistant | 115 E 7th St, Manton, MI 49663-9429 | 2013-08-27 |
| 1669766705 | Manton Health Center,p LLC | Family Medicine | 115 E 7th St, Manton, MI 49663-9429 | 2011-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639454986 | Manton Family Pharmacy Inc | Pharmacy | 117 W Main St, Manton, MI 49663 | 2011-10-19 |
| 1477641926 | Bostick Drug Store Inc | Pharmacy | 117 W Main St, Manton, MI 49663 | 2006-10-10 |
| 1669862546 | Hilda Schut | Massage Therapist | 7144 E 14 Rd, Manton, MI 49663-8600 | 2015-01-29 |
| 1821549858 | Katie Gardner | Specialist/Technologist | 5851 W Moorestown Rd, Manton, MI 49663-9012 | 2016-10-14 |
| 1558900720 | Manton Family Pharmacy Inc | Pharmacy | 117 W Main St, Manton, MI 49663-9026 | 2020-01-05 |
| 1578817854 | Bonnie Lou Perkins/crackel | Contractor | 116 Roberts St, Manton, MI 49663-9124 | 2012-11-07 |
| 1093287203 | Stephen Hooper | Transportation Broker | 212 Pine St, Manton, MI 49663-9128 | 2018-12-28 |
| 1922551852 | Manton Medical Equipment, LLC | Health Maintenance Organization | 113 E Main St, Manton, MI 49663-9152 | 2016-07-27 |
| 1578992459 | Karla Long | Physical Therapy Assistant | 413 W Main St, Manton, MI 49663-9156 | 2013-11-01 |
| 1518358779 | Mary Schmidt | Registered Nurse | 9091 W Walker Rd, Manton, MI 49663-9311 | 2015-02-10 |
| Find all providers in zip 49663 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669766705 | Manton Health Center,p LLC | Family Medicine | 115 E 7th St, Manton, MI 49663-9429 | 2011-06-07 |
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| 1710592050 | Chippewa County War Memorial Hospital Inc | Family Medicine | 391 E M 134, Cedarville, MI 49719-9451 | 2020-09-14 |
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| 1457961054 | Danna Zevy | Family Medicine | 107 S Washington Ave Apt 401, Saginaw, MI 48607-1258 | 2020-08-07 |
| 1194342808 | Zachary Hillman Do Pllc | Family Medicine | 1794 N Lapeer Rd Ste A, Lapeer, MI 48446-7664 | 2020-06-29 |
| 1336765445 | Spectrum Health United | Family Medicine | 7188 Avenue B, Vestaburg, MI 48891-9502 | 2020-06-24 |
| 1477179711 | Spectrum Health United | Family Medicine | 1324 N County Line Rd, Blanchard, MI 49310-9303 | 2020-06-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.