Marshall R. Wickens DO, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101011160 Issued in MI

Legal business name

MARSHALL R. WICKENS DO, PC

Practice address

207 S Chestnut St Unit B
Reed City, MI 49677-1205

Phone

(231) 832-9488

Fax

(231) 832-9348

NPI assigned

Nov 13, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Marshall Robert Wickens, DONPI 1841263134

Title

Owner

Phone

(231) 832-9488

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

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.

• Marshall Wickens, DO

  • Family Medicine Physician
  • Reed City, MI
  • NPI 1841263134
  Medicare reassignment NPD Authorized official
• Ann L Truax, NP

  • Nurse Practitioner
  • Reed City, MI
  • NPI 1861459059
  Medicare reassignment NPD

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

{
    "created_epoch": "1415836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415836800000",
    "number": "1043616378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 S CHESTNUT ST UNIT B",
            "city": "REED CITY",
            "state": "MI",
            "postal_code": "496771205",
            "telephone_number": "231-832-9488",
            "fax_number": "231-832-9348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 S CHESTNUT ST UNIT B",
            "city": "REED CITY",
            "state": "MI",
            "postal_code": "496771205",
            "telephone_number": "231-832-9488",
            "fax_number": "231-832-9348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL R. WICKENS DO, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-13",
        "last_updated": "2014-11-13",
        "status": "A",
        "authorized_official_last_name": "WICKENS",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-832-9488",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101011160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Reed City, MI
• Providers in Reed City, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.