NPIMap

Organization Active NPI

Family Medical Center of Michigan, Inc

Doing business as Family Medical Center of Michigan, Inc- Waterloo

  • Federally Qualified Health Center (FQHC)
  • Monroe, MI
National Provider Identifier
1114598125
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY MEDICAL CENTER OF MICHIGAN, INC
Doing business as
Family Medical Center of Michigan, Inc- Waterloo
Practice address
1933 S Custer Rd RM 101
Monroe, MI 48161-1828
Phone
(734) 243-2410
Fax
(734) 639-2552
NPI assigned
Jul 9, 2021
Last updated
Jul 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

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

Authorized official

Name
Shaelise Harris
Title
Patient Accounts Assistant Manager
Phone
(734) 847-3802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1933 S Custer Rd RM 101
Monroe, MI 48161-1828

Mailing address

8765 Lewis Ave
Temperance, MI 48182-9300
Phone (734) 847-3802

Other names 1

  • FAMILY MEDICAL CENTER OF MICHIGAN, INC- WATERLOO Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Family Medical Clinic92 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

1933 S Custer Rd
Rm 101
Monroe, MI 48161
Phone (734) 243-2410

Practitioners & affiliated clinicians

Practitioners 1

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": "1625788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1114598125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8765 LEWIS AVE",
            "city": "TEMPERANCE",
            "state": "MI",
            "postal_code": "481829300",
            "telephone_number": "734-847-3802",
            "fax_number": "734-850-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 S CUSTER RD RM 101",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481611828",
            "telephone_number": "734-243-2410",
            "fax_number": "734-639-2552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CENTER OF MICHIGAN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-07-09",
        "certification_date": "2021-06-14",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "SHAELISE",
        "authorized_official_title_or_position": "PATIENT ACCOUNTS ASSISTANT MANAGER",
        "authorized_official_telephone_number": "734-847-3802"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY MEDICAL CENTER OF MICHIGAN, INC- WATERLOO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; 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.