Provider Demographics
NPI:1548322548
Name:BART ANTHONY PC
Entity type:Organization
Organization Name:BART ANTHONY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:248-338-2988
Mailing Address - Street 1:43996 WOODWARD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5027
Mailing Address - Country:US
Mailing Address - Phone:248-338-2988
Mailing Address - Fax:248-338-1322
Practice Address - Street 1:43996 WOODWARD AVE
Practice Address - Street 2:STE 101
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5027
Practice Address - Country:US
Practice Address - Phone:248-338-2988
Practice Address - Fax:248-338-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI631300101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20530OtherBCBSM SUBSTANCE ABUSE
MI1705289Medicaid
20530OtherBC SUBSTANCE ABUSE
MI1705289Medicaid
MIOM808Medicare PIN