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FENTON MEDICAL CENTER NPI 1134165632


NPI Information

NPI: 1134165632
Provider Name: FENTON MEDICAL CENTER
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 23D0706351

Address:
102 N ADELAIDE ST
FENTON, MI
ZIP 48430
Phone: (810) 629-2245
Get Directions

FENTON MEDICAL CENTER is a family medicine in Fenton, MI. The provider is 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. FENTON MEDICAL CENTER NPI is 1134165632. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

102 N ADELAIDE ST
FENTON, MI
ZIP 48430-670
Phone: (810) 629-2245
Fax: (810) 629-6535

The provider's authorized official is Deborah L Duncan .
The authorized official title is Physician/owner and has the following contact phone number (810) 629-2245.

The CLIA number assigned to this NPI record is 23D0706351 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/22/2006 and was last updated on 4/14/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician AssistantNo
2207RC0000XInternal MedicineCardiovascular Disease4301038438MICHIGANNo
3207R00000XInternal MedicineNo
4207RA0000XInternal MedicineAdolescent MedicineNo
5207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1B562569082MEDICARE ID-TYPE UNSPECIFIEDMICHIGANGROUP ID #
2OB56256OTHERMICHIGANBCBS GROUP ID MI
3=========OTHERMICHIGANTAX ID #
4W515OTHERMICHIGANMCARE GROUP ID #
5G01521OTHERMICHIGANBCN GROUP ID #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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