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EAST SIDE MEDICAL SERVICES P C NPI 1629384144


NPI Information

NPI: 1629384144
Provider Name: EAST SIDE MEDICAL SERVICES P C

Other Name: EDGEWOOD CLINIC

Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 23D0365475

Address:
22790 HARPER AVE
SUITE A
SAINT CLAIR SHORES, MI
ZIP 48080
Phone: (586) 445-3070
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EAST SIDE MEDICAL SERVICES P C is a specialist in Saint Clair Shores, MI. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. EAST SIDE MEDICAL SERVICES P C NPI is 1629384144. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Edgewood Clinic.

The provider's business location address is:

22790 HARPER AVE
SUITE A
SAINT CLAIR SHORES, MI
ZIP 48080-831
Phone: (586) 445-3070
Fax: (586) 445-3072

The provider's authorized official is Mohd S Jafri .
The authorized official title is Doctor and has the following contact phone number (586) 445-3070.

The CLIA number assigned to this NPI record is 23D0365475 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/21/2010 and was last updated on 1/5/2011.


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
1174400000XSpecialist4301031532MICHIGANYes

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
11285498MEDICAIDMICHIGAN
235002138111MEDICARE PINMICHIGAN
3B49012MEDICARE UPINMICHIGAN

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.