Cedar Street Family Medicine PC
Organization Active NPI Family Medicine Physician · Mason, MI
NPI 1063713238 · NPPES record last updated Nov 4, 2010
Key facts
- NPI
- 1063713238
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 5101013448 (MI)
- Legal business name
- CEDAR STREET FAMILY MEDICINE PC
- Practice address
- 806 Hogsback Rd
Suite C
Mason, MI 48854-9569 - Phone
- (517) 244-1000
- Fax
- (517) 244-1030
- NPI assigned
- Nov 4, 2010
- Organization subpart
- No
Authorized official
- Name
- Corrine Garner, DO
- Title
- Owner
- Phone
- (517) 244-1000
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041210000641 | MI | Part B Supplier - Clinic/Group Practice | 3678530656 |
Receives reassigned benefits from 1 practitioner Practice locations: Mason, MI |
National Provider Directory
Locations
801 S Cedar St
Ste B
Mason, MI 48854
Phone (517) 244-0434
710 Temple St
Mason, MI 48854
Phone (517) 244-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 5101013448 | MI | Yes |
Addresses
Primary practice location
806 Hogsback Rd
Suite C
Mason, MI 48854-9569
Mailing address
PO Box 126
Mason, MI 48854
Phone (517) 244-1000
Other providers in Mason, MI
- Rachel Lucille Carlson
- Katy R Carnes
- Amanda Marie Carr
- Linda Carter
- Christina Cattivera
- Jonathon Cejmer
- Lizette Chacon
- Chalcedony Wellness Services LLC
- Trevor James Chamberlin
- Stephanie Lee Chapman
All providers in Mason, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.