Organization Active NPI

Midwesthealthcenter

  • General Practice Physician
  • Dearborn, MI
National Provider Identifier
1497931695
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MIDWESTHEALTHCENTER
Practice address
5050 Schaefer Rd
Dearborn, MI 48126-3249
Phone
(313) 581-2600
Fax
(313) 581-0228
NPI assigned
Jan 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Authorized official

Name
Lee Ann Odom
Title
President Shared Services
Phone
(947) 522-3326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X MI Primary

Addresses

Primary practice location

5050 Schaefer Rd
Dearborn, MI 48126-3249

Mailing address

26901 Beaumont Blvd
Compliance
Southfield, MI 48033-3849
Phone (947) 522-1964

Other identifiers 2

IdentifierTypeStateIssuer
3098064MedicaidMI
0H261900OtherMIBCBSM

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1200528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1497931695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD",
            "address_2": "COMPLIANCE",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 SCHAEFER RD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263249",
            "telephone_number": "313-581-2600",
            "fax_number": "313-581-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWESTHEALTHCENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-17",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT SHARED SERVICES",
        "authorized_official_telephone_number": "947-522-3326"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3098064",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0H261900",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.