| Health Centers Detroit Medicalgroup | |
|
7633 E Jefferson Ave Suite 340 Detroit MI 48214-3730 | |
| (313) 822-9801 | |
| (313) 822-1030 |
| Full Name | Health Centers Detroit Medicalgroup |
|---|---|
| Speciality | Clinic/Center |
| Location | 7633 E Jefferson Ave, Detroit, Michigan |
| Authorized Official Name and Position | Herbert C. Smitherman (PRESIDENT & CEO) |
| Authorized Official Contact | 3139665187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Health Centers Detroit Medicalgroup 7633 E Jefferson Ave Suite 340 Detroit MI 48214-3730 Ph: (313) 822-9801 | Health Centers Detroit Medicalgroup 7633 E Jefferson Ave Suite 340 Detroit MI 48214-3730 Ph: (313) 822-9801 |
| NPI Number | 1518026541 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 01/20/2012 |
| Medicare PECOS PAC ID | 4284539081 |
|---|---|
| Medicare Enrollment ID | O20031204000807 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518026541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 443750 (Michigan) | Primary |
| Provider Name | Alfred Kwamena Newton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1851302608 PECOS PAC ID: 8325944614 Enrollment ID: I20031209000144 |
| Provider Name | Everett W Campbell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710046792 PECOS PAC ID: 8527032267 Enrollment ID: I20040819001356 |
| Provider Name | Herbert Charles Smitherman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518905637 PECOS PAC ID: 8921903733 Enrollment ID: I20060630000271 |
| Provider Name | Katrice L Herndon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407969827 PECOS PAC ID: 7214936400 Enrollment ID: I20061218000089 |
| Provider Name | Andrew A Avery |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255587945 PECOS PAC ID: 2668531195 Enrollment ID: I20081112000547 |
| Provider Name | Roy Elrod |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306883541 PECOS PAC ID: 7911921564 Enrollment ID: I20100130000333 |
| Provider Name | James E Haney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184782138 PECOS PAC ID: 0244366201 Enrollment ID: I20100329000864 |
| Provider Name | Dawn D Foster |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750449708 PECOS PAC ID: 1153450721 Enrollment ID: I20100520000617 |
| Provider Name | Anthony W Clarke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811055858 PECOS PAC ID: 4880618453 Enrollment ID: I20100520000661 |
| Provider Name | Ralph E Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396942454 PECOS PAC ID: 4385837186 Enrollment ID: I20101026000082 |
| Provider Name | Shyran J Hines-fenderson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699933721 PECOS PAC ID: 3274727862 Enrollment ID: I20101027001076 |
| Provider Name | Nicole M Massie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255536926 PECOS PAC ID: 4880872183 Enrollment ID: I20110708000168 |
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