MICHAEL STACK MD PC NPI 1376580175

NPI Information

NPI: 1376580175
Provider Name: MICHAEL STACK MD PC

Doing Business As: FAMILY MEDICAL CARE

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
121 N PINE RIVER ST
ITHACA, MI
ZIP 48847
Phone: (989) 875-5111
Get Directions

MICHAEL STACK MD PC is a rural health clinic center in Ithaca, MI. MICHAEL STACK MD PC NPI is 1376580175. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Family Medical Care.

The provider's business location address is:

121 N PINE RIVER ST
ITHACA, MI
ZIP 48847-039
Phone: (989) 875-5111
Fax: (989) 875-5023

The provider's authorized official is Michael Andrew Stack .
The authorized official title is Owner and has the following contact phone number (989) 875-5111.

The CLIA number assigned to this NPI record is 23D0904212 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/1/2006 and was last updated on 1/8/2009.

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
1	207Q00000X	Family Medicine			MICHIGAN	No
2	363LF0000X	Nurse Practitioner	Family		MICHIGAN	No
3	261QR1300X	Clinic/Center	Rural Health	4301064712	MICHIGAN	Yes

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
1	0N55970	MEDICARE PIN	MICHIGAN
2	0B91071	OTHER	MICHIGAN	BCBSM
3	233971	MEDICARE OSCAR/CERTIFICATION	MICHIGAN

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

NPI Synchronization or Removal

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