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ST CLAIRE SHORES MEDICAL PLLC NPI 1316194640


NPI Information

NPI: 1316194640
Provider Name: ST CLAIRE SHORES MEDICAL PLLC
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

Address:
30140 HARPER AVE
SUITE 300
SAINT CLAIR SHORES, MI
ZIP 48082
Phone: (586) 293-1848
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ST CLAIRE SHORES MEDICAL PLLC is a medical specialty clinic center in Saint Clair Shores, MI. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). ST CLAIRE SHORES MEDICAL PLLC NPI is 1316194640. The provider is registered as an organization entity type.

The provider's business location address is:

30140 HARPER AVE
SUITE 300
SAINT CLAIR SHORES, MI
ZIP 48082-610
Phone: (586) 293-1848
Fax: (586) 293-1869

The provider's authorized official is Bernard W Shelton .
The authorized official title is Sole Proprietor and has the following contact phone number (586) 293-1868.

The enumeration date for this NPI number is 8/18/2008 and was last updated on 10/8/2014.


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
1261QM2500XClinic/CenterMedical Specialty4301088798MICHIGANYes

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
11417032491OTHERMICHIGANNPI
24945780-10MEDICAIDMICHIGAN
30502329OTHERMICHIGANBCBS
40P62160MEDICARE PINMICHIGAN
5165509MEDICARE UPINMICHIGAN
670-0-F32947-0OTHERMICHIGANBCBS CPIN#

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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