Northridge Family Practice Llc
LBN: Northridge Family Practice Llc
Northridge Family Practice Llc is an health care organization with primary practice located at 3190 Northridge Drive , Hale MI 48739-9276. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology. Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology is the primary health care specialty.
Northridge Family Practice Llc can be contacted via phone (989) 728-6000, or through Provoast, Debra via phone (989) 728-6000.
Contact Information
Primary practice address
3190 Northridge Drive
Hale MI 48739-9276
Phone: (989) 728-6000
Fax: (989) 728-6003
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 4301061417 | Michigan |
| Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology | 207RC0001X | 5101011670 | Michigan |
Profile Details
| NPI number | 1780803932 |
|---|---|
| LBN Legal business name | Northridge Family Practice Llc |
| DBA Doing business as | |
| Authorized official | Provoast, Debra Nurse Practitioner (NP) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 25th, 2007 |
| Last updated | Jan 13th, 2009 - about 15 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780803932 | NPPES |
| Michigan | Other | MA061417 | MOHAMED ALI |
| Michigan | Other | DL074550 | MOHAMED ALI |
| Michigan | MEDICAID | 104289418 | MOHAMED ALI |
| Michigan | MEDICAID | 114811801 | MOHAMED ALI |
| Michigan | Other | 080C510310 | MOHAMED ALI |
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