NPIMap

Organization Active NPI

Southfort Family Clinic PC

  • Family Medicine Physician
  • Southgate, MI
National Provider Identifier
1184801318
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301067719 Issued in MI
Legal business name
SOUTHFORT FAMILY CLINIC PC
Practice address
13650 Fort St
Southgate, MI 48195-1152
Phone
(734) 281-2150
NPI assigned
Jan 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

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

Authorized official

Name
Edward Nazareno, MD
Title
President
Phone
(734) 281-2150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 4301067719 MI Primary

Addresses

Primary practice location

13650 Fort St
Southgate, MI 48195-1152

Mailing address

13650 Fort St
Southgate, MI 48195-1152
Phone (734) 281-2150

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201651200000",
    "number": "1184801318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13650 FORT ST",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951152",
            "telephone_number": "734-281-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13650 FORT ST",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951152",
            "telephone_number": "734-281-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFORT FAMILY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-30",
        "last_updated": "2008-01-30",
        "status": "A",
        "authorized_official_last_name": "NAZARENO",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-281-2150",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301067719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; 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.