Provider Demographics
NPI:1730248410
Name:NORTH STREET MEDICAL CENTER P C
Entity type:Organization
Organization Name:NORTH STREET MEDICAL CENTER P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN & PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:S
Authorized Official - Last Name:FLANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-723-5136
Mailing Address - Street 1:1457 N. M-52
Mailing Address - Street 2:UNIT 2
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48667
Mailing Address - Country:US
Mailing Address - Phone:989-723-5136
Mailing Address - Fax:989-723-8269
Practice Address - Street 1:1457 N. M-52
Practice Address - Street 2:UNIT 2
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-723-5136
Practice Address - Fax:989-723-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G86012Medicare ID - Type Unspecified