Vandyke Medical Clinic Management Corp

LBN: Vandyke Medical Clinic Management Corp
Vandyke Medical Clinic Management Corp is an health care organization with primary practice located at 19431 Van Dyke St , Detroit MI 48234-3323. The organization recently has only one registered license in Ambulatory Health Care Facilities / Health Service, which is considered as the primary health care specialty. Vandyke Medical Clinic Management Corp can be contacted via phone (313) 893-2010, or through Mullen, Ernest A via phone (313) 893-2010.

Contact Information

Primary practice address
19431 Van Dyke St Detroit MI 48234-3323
Phone: (313) 893-2010
Fax: (313) 893-3308
Website:
Map and Directions
Authorized official contact:
Name: Mullen, Ernest A Doctor of Medicine (MD)
Phone: (313) 893-2010

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Health Service 261QH0100X 4301081357 Michigan

Profile Details

NPI number 1174632087
LBN Legal business name Vandyke Medical Clinic Management Corp
DBA Doing business as
Authorized official Mullen, Ernest A Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 30th, 2006
Last updated Dec 1st, 2015 - about 10 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174632087 NPPES
Michigan MEDICAID 4796189 TYPE 10
Michigan Other 080H249740

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