NPIMap

Organization Active NPI

Provemont Family Care, PLC

  • Primary Care Clinic/Center
  • Lake Leelanau, MI
National Provider Identifier
1013109214
Registry record updated Aug 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
5101016681 Issued in MI
Legal business name
PROVEMONT FAMILY CARE, PLC
Practice address
49 N Eagle Hwy
Lake Leelanau, MI 49653-9778
Phone
(231) 256-0606
Fax
(231) 256-0671
NPI assigned
Aug 13, 2007
Last updated
Aug 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dona D. Alba, DO
Title
President
Phone
(231) 256-0606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 5101016681 MI Primary

Addresses

Primary practice location

49 N Eagle Hwy
Lake Leelanau, MI 49653-9778

Mailing address

PO Box 180
Lake Leelanau, MI 49653-0180
Phone (231) 256-0606

Other identifiers 2

IdentifierTypeStateIssuer
1164458295OtherNPI
4849101MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186963200000",
    "number": "1013109214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 180",
            "city": "LAKE LEELANAU",
            "state": "MI",
            "postal_code": "496530180",
            "telephone_number": "231-256-0606",
            "fax_number": "231-256-0671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 N EAGLE HWY",
            "city": "LAKE LEELANAU",
            "state": "MI",
            "postal_code": "496539778",
            "telephone_number": "231-256-0606",
            "fax_number": "231-256-0671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVEMONT FAMILY CARE, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2007-08-13",
        "status": "A",
        "authorized_official_last_name": "ALBA",
        "authorized_official_first_name": "DONA",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-256-0606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "5101016681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1164458295",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4849101",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Leelanau, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.