Provider Demographics
NPI:1730245499
Name:FRANCIS STREET MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:FRANCIS STREET MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-784-8546
Mailing Address - Street 1:143 WEST PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203
Mailing Address - Country:US
Mailing Address - Phone:517-784-8546
Mailing Address - Fax:517-784-8538
Practice Address - Street 1:143 WEST PROSPECT ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203
Practice Address - Country:US
Practice Address - Phone:517-784-8546
Practice Address - Fax:517-784-8538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHD007157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0721OtherHEALTH PLAN OF MICHIGAN
MI080C812780OtherBCBS
MI1300262Medicaid
5133877OtherBLUE CARE NETWORK
120129OtherPHP
10020OtherGREAT LAKES HEALTH PLAN
MI080C812780OtherBCBS
120129OtherPHP