Port Huron Clinic P.C.

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

003615 Issued in MI

Legal business name

PORT HURON CLINIC P.C.

Practice address

1107 Stone St
Ste #1
Port Huron, MI 48060-3569

Phone

(810) 982-8300

Fax

(810) 982-8308

NPI assigned

Jun 10, 2006

Organization subpart

No

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

Authorized official

Name

Mortimer Levin, DO

Title

Director

Phone

(248) 569-5100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Tax ID family

Port Huron Clinic P C2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Universal Clinic P.C.

  • Legal Medicine
  • Southfield, MI
  • NPI 1104860212
  NPD tax ID

Locations

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218672000000",
    "number": "1093756934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480370198",
            "telephone_number": "248-569-5100",
            "fax_number": "248-569-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 STONE ST",
            "address_2": "STE #1",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603569",
            "telephone_number": "810-982-8300",
            "fax_number": "810-982-8308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT HURON CLINIC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2008-08-14",
        "status": "A",
        "authorized_official_last_name": "LEVIN",
        "authorized_official_first_name": "MORTIMER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "248-569-5100",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "MI",
            "license": "003615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Marie Polio
• Victor Paul Polito Jr.
• Thomas P Pope, LLP
• Port Huron Anesthesiology, PC
• Port Huron Behavioral Specialists
• Port Huron Counseling Behavioral Specialist
• Port Huron Family Care PLLC
• Port Huron Hospital Crna Billing, LLC
• Port Huron Internal Medicine
• Port Huron Internal Medicine Associates

• Legal Medicine in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Legal Medicine in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.