| Primary Care Clinic Of Jackson, P.c. | |
|
2218 Sugarloaf Ave Portage MI 49024-6771 | |
| (269) 327-9700 | |
| (269) 327-9701 |
| Full Name | Primary Care Clinic Of Jackson, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2218 Sugarloaf Ave, Portage, Michigan |
| Authorized Official Name and Position | Tahir A Alvi (PRESIDENT) |
| Authorized Official Contact | 2693279700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Clinic Of Jackson, P.c. Po Box 1599 Jackson MI 49204-1599 Ph: (269) 327-9700 | Primary Care Clinic Of Jackson, P.c. 2218 Sugarloaf Ave Portage MI 49024-6771 Ph: (269) 327-9700 |
| NPI Number | 1821278193 |
|---|---|
| Provider Enumeration Date | 11/05/2007 |
| Last Update Date | 07/20/2009 |
| Medicare PECOS PAC ID | 6608909478 |
|---|---|
| Medicare Enrollment ID | O20100730000012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821278193 | NPI | - | NPPES |
| 3397804 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | TA065207 (Michigan) | Primary |
| Provider Name | Tahir A Alvi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174509855 PECOS PAC ID: 6204881360 Enrollment ID: I20050322000440 |
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