Provider Service Organization

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

PROVIDER SERVICE ORGANIZATION

Practice address

7233 Provincial CT
Canton, MI 48187-2121

Phone

(734) 516-4239

Fax

(734) 404-5292

NPI assigned

Feb 29, 2016

Organization subpart

No

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

Authorized official

Name

Ramon Villanueva

Title

President

Phone

(734) 516-4239

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465171200000",
    "number": "1447610704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7233 PROVINCIAL CT",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872121",
            "telephone_number": "734-516-4239",
            "fax_number": "734-404-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7233 PROVINCIAL CT",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872121",
            "telephone_number": "734-516-4239",
            "fax_number": "734-404-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDER SERVICE ORGANIZATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-29",
        "last_updated": "2016-06-06",
        "status": "A",
        "authorized_official_last_name": "VILLANUEVA",
        "authorized_official_first_name": "RAMON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-516-4239"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Family Medicine) Physician in Canton, MI
• Providers in Canton, MI by specialty
• Geriatric Medicine (Family Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; 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.