Shiawassee Physician Services

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301042819 Issued in MI

Legal business name

SHIAWASSEE PHYSICIAN SERVICES

Practice address

208 N Shiawassee St
Owosso, MI 48867-2755

Phone

(989) 723-9796

Fax

(989) 725-2383

NPI assigned

Jul 7, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ekram M Smith, MD

Title

President

Phone

(989) 723-9796

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477872000000",
    "number": "1679505804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 N SHIAWASSEE ST",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "48867",
            "telephone_number": "989-723-9796",
            "fax_number": "989-729-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 N SHIAWASSEE ST",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488672755",
            "telephone_number": "989-723-9796",
            "fax_number": "989-725-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIAWASSEE PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2016-10-31",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "EKRAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "989-723-9796",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301042819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0807800101",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3940611",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679505804",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shiawassee County Community Mental Health Authority
• Shiawassee County Medical Group
• Shiawassee County Medical Group
• Shiawassee Optical Associates
• Shiawassee Pediatrics PC
• Shiawassee Spinal Center
• Shiawassee Spinal Center, PC
• Michelle Ann Shields, M.D.
• Cathy Shive
• Makayla Shown

• All providers in Owosso, MI
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.