NPIMap

Organization Active NPI

John Street Clinic PC

  • Internal Medicine Physician
  • Lake City, MI
National Provider Identifier
1033253133
Registry record updated Aug 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
JOHN STREET CLINIC PC
Practice address
112 E John St
Lake City, MI 49651
Phone
(231) 839-4359
Fax
(231) 839-0223
NPI assigned
Feb 20, 2007
Last updated
Aug 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2010

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

Authorized official

Name
Sotero M Ureta, M.D.
Title
Owner
Phone
(231) 839-4359

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X

Addresses

Primary practice location

112 E John St
Lake City, MI 49651

Mailing address

PO Box 213
Cadillac, MI 49601-0213
Phone (231) 775-6076

National Provider Directory

National Provider Directory

Locations

235 Pearl St
Cadillac, MI 49601
Phone (231) 775-5300

2439 E Houghton Lake Rd
Lake City, MI 49651
Phone (231) 328-4695

Practitioners & affiliated clinicians

Practitioners 3

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": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280966400000",
    "number": "1033253133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 213",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496010213",
            "telephone_number": "231-775-6076",
            "fax_number": "231-775-0027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 E JOHN ST",
            "city": "LAKE CITY",
            "state": "MI",
            "postal_code": "49651",
            "telephone_number": "231-839-4359",
            "fax_number": "231-839-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN STREET CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2010-08-05",
        "status": "A",
        "authorized_official_last_name": "URETA",
        "authorized_official_first_name": "SOTERO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-839-4359",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; 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.