Provider Demographics
NPI:1861766065
Name:SUPERIOR FAMILY MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:SUPERIOR FAMILY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAAK
Authorized Official - Middle Name:MART
Authorized Official - Last Name:PAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-632-0370
Mailing Address - Street 1:550 OSBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1899
Mailing Address - Country:US
Mailing Address - Phone:906-632-0370
Mailing Address - Fax:906-632-6373
Practice Address - Street 1:550 OSBORN BLVD
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1899
Practice Address - Country:US
Practice Address - Phone:906-632-0370
Practice Address - Fax:906-632-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2114539Medicaid
OA71078OtherBLUE CROSS BLUE SHIELD GROUP PIN
OA71078OtherBLUE CROSS BLUE SHIELD GROUP PIN