Boardman Health and Wellness, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301069428 Issued in MI

Legal business name

BOARDMAN HEALTH AND WELLNESS, PLLC

Practice address

4713 Pine St SW
South Boardman, MI 49680-9761

Phone

(231) 369-2656

Fax

(231) 369-2657

NPI assigned

Dec 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas K Stetler, PA-CNPI 1164531794

Title

Practice Owner

Phone

(231) 369-2656

Specialties & licenses 1

Addresses

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.

• Thomas Keane Stetler, PA-C

  • Physician Assistant
  • S Boardman, MI
  • NPI 1164531794
  Authorized official Same address or phone

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437213667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 PINE ST SW",
            "city": "SOUTH BOARDMAN",
            "state": "MI",
            "postal_code": "496809761",
            "telephone_number": "231-369-2656",
            "fax_number": "231-369-2657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4713 PINE ST SW",
            "city": "SOUTH BOARDMAN",
            "state": "MI",
            "postal_code": "496809761",
            "telephone_number": "231-369-2656",
            "fax_number": "231-369-2657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARDMAN HEALTH AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STETLER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "231-369-2656",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301069428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boardman Family Practice PLLC
• Katelyn R. Crain
• Rachel Lynn Johnson
• Todd M Kreykes, PA.C
• Restorative Outdoor Services LLC

• Family Medicine Physician in South Boardman, MI
• Providers in South Boardman, 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 Aug 22, 2020; 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.