| Up North Medical Centers | |
|
1951 S Otsego Ave Gaylord MI 49735-8489 | |
| (989) 732-3284 | |
| (989) 732-6395 |
| Full Name | Up North Medical Centers |
|---|---|
| Speciality | Clinic/Center |
| Location | 1951 S Otsego Ave, Gaylord, Michigan |
| Authorized Official Name and Position | Destiney Green (BILLING MANAGER) |
| Authorized Official Contact | 9897323284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Up North Medical Centers 1951 S Otsego Ave Gaylord MI 49735-8489 Ph: (989) 732-3284 | Up North Medical Centers 1951 S Otsego Ave Gaylord MI 49735-8489 Ph: (989) 732-3284 |
| NPI Number | 1972556702 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 10/06/2022 |
| Medicare PECOS PAC ID | 3173565850 |
|---|---|
| Medicare Enrollment ID | O20050523001240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972556702 | NPI | - | NPPES |
| 080B410910 | Other | MI | BLUE CROSS BLUE SHIELD GR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Primary |
| Provider Name | Richard E Mansfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518922988 PECOS PAC ID: 3375533979 Enrollment ID: I20040515000146 |
| Provider Name | David R Hunter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447276167 PECOS PAC ID: 6709888589 Enrollment ID: I20070207000370 |
| Provider Name | Tammy Broz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609392802 PECOS PAC ID: 0244596674 Enrollment ID: I20171117000585 |
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