| Pine Trees Medical Office Pc | |
|
11610 Waldron Rd Jerome MI 49249-9637 | |
| (517) 688-4842 | |
| (517) 688-4842 |
| Full Name | Pine Trees Medical Office Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11610 Waldron Rd, Jerome, Michigan |
| Authorized Official Name and Position | Roy W Boyer (PRESIDENT) |
| Authorized Official Contact | 5176884842 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Trees Medical Office Pc 11610 Waldron Rd Jerome MI 49249-9637 Ph: (517) 688-4842 | Pine Trees Medical Office Pc 11610 Waldron Rd Jerome MI 49249-9637 Ph: (517) 688-4842 |
| NPI Number | 1487648374 |
|---|---|
| Provider Enumeration Date | 09/07/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487648374 | NPI | - | NPPES |
| P41335 | Other | MI | BLUE CARE NETWORK HMO |
| 1 106914130 | Other | MI | BCBS |
| 4462854 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301028315 (Michigan) | Primary |