PORT HURON PHYSICIANS MEDICAL GROUP PC (NPI# 1902281736) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902281736 |
| Entity Type | Organization |
| Organization Name | PORT HURON PHYSICIANS MEDICAL GROUP PC |
| Practice Address |
4190 24th Ave Ste 206 Fort Gratiot MI 48059-3882 |
| Practice Telephone | 8109897700 |
| Mailing Telephone | 8109897700 |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2015-07-22 |
| Authorized Official Name | REBEKAH SMITH (CEO) |
| Authorized Official Telephone | 8109851510 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598141640 | Port Huron Physicians Medical Group PC | Internal Medicine | 4190 24th Ave, Suite 206, Fort Gratiot, MI 48059-3882 | 2015-07-30 |
| Street Address |
4190 24TH AVE STE 206 |
| City | FORT GRATIOT |
| State | MI |
| Zip Code | 48059-3882 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629079611 | Newco Ambulatory Surgery Center, LLP | Clinic/Center | 4190 24th Ave, Fort Gratiot, MI 48059-3882 | 2005-08-02 |
| 1518513027 | Aiso Pllc | Clinic/Center | 4190 24th Ave, Fort Gratiot, MI 48059-3882 | 2019-08-12 |
| 1588109177 | Heather Kakos | Nurse Anesthetist, Certified Registered | 4190 24th Ave, Fort Gratiot, MI 48059-3882 | 2017-01-05 |
| 1891246021 | Lake Huron Urgent Care Center, LLC | Internal Medicine | 4190 24th Ave, Fort Gratiot, MI 48059-3882 | 2016-10-24 |
| 1134586852 | Prime Healthcare Services-port Huron, LLC | Clinic/Center | 4190 24th Ave, Fort Gratiot, MI 48059-3882 | 2016-01-26 |
| 1598141640 | Port Huron Physicians Medical Group PC | Internal Medicine | 4190 24th Ave, Suite 206, Fort Gratiot, MI 48059-3882 | 2015-07-30 |
| 1033505110 | Prime Garden City Medical Group | Internal Medicine | 4190 24th Ave, Suite 206, Fort Gratiot, MI 48059-3882 | 2015-04-15 |
| 1003204660 | Beverlie Houser | Nurse Practitioner | 4190 24th Ave, Fort Gratiot, MI 48059-3882 | 2015-01-06 |
| 1942615414 | Mercy Surgery Care Network | Internal Medicine | 4190 24th Ave, Suite 206, Fort Gratiot, MI 48059-3882 | 2014-06-24 |
| 1740424001 | Rashim K Gupta | Internal Medicine | 4190 24th Ave, Suite 206, Fort Gratiot, MI 48059-3882 | 2009-04-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679096374 | Rebecca Campau | Registered Nurse | 4985 Lakeshore Rd, Fort Gratiot, MI 48059 | 2017-07-25 |
| 1598175481 | David Kelley Sr. | Pharmacist | 4475 24th Ave., Fort Gratiot, MI 48059 | 2014-05-01 |
| 1316110968 | Apheresis and Transfusion Medicine of Port Huron Pllc | Pathology | 4970 Lakeshore Road, Fort Gratiot, MI 48059 | 2008-04-03 |
| 1275754152 | Jennifer Ann Peyerk | Physical Therapist | 3902 Arlington Ave., Fort Gratiot, MI 48059 | 2007-05-01 |
| 1013097278 | Randy John Plonka | Internal Medicine | 5979 Lakeshore, Ft Gratiot, MI 48059 | 2006-10-16 |
| 1881708428 | John Nathan Seppo | Social Worker | 3847 Pine Grove Avenue, Fort Gratiot, MI 48059 | 2006-08-19 |
| 1396756615 | Blue Water Family Dentistry PC | Dentist | 4044 24th Ave, Fort Gratiot, MI 48059 | 2006-08-11 |
| 1720018823 | Minden City Community Healthcare Outreach | Clinic/Center | 28 Deer Creek Drive, Fort Gratiot, MI 48059 | 2006-07-04 |
| 1982103966 | Luke Michael Privette | Physical Therapist | 4351 24th Ave Ste 1, Fort Gratiot, MI 48059 | 2018-02-06 |
| 1194115352 | Rachel Brooks | Chiropractor | 2844 Krafft Rd, Fort Gratiot, MI 48059 | 2015-01-27 |
| Find all providers in zip 48059 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1245739903 | Breanna Lee Brookens | General Practice | 1531 Barnard St, Saginaw, MI 48602-4902 | 2018-02-08 |
| Find all providers with the same taxonomy | ||||
| City | FORT GRATIOT |
| Zip Code | 48059 |
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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.