NPIMap

Organization Active NPI

Boardman Family Practice PLLC

  • Rural Health Clinic/Center
  • South Boardman, MI
National Provider Identifier
1740564681
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BOARDMAN FAMILY PRACTICE PLLC
Practice address
4713 Pine St SW
South Boardman, MI 49680-9761
Phone
(231) 518-0189
Fax
(231) 518-0188
NPI assigned
Oct 10, 2011
Last updated
Mar 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

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

Authorized official

Name
Todd Kreykes, PANPI 1750366308
Title
Owner
Phone
(231) 624-1054

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 5101013379 MI
Rural Health Clinic/Center 261QR1300X Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X 5601002729 MI

Addresses

Primary practice location

4713 Pine St SW
South Boardman, MI 49680-9761

Mailing address

4713 Pine St SW
South Boardman, MI 49680-9761
Phone (231) 518-0189

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1318204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1740564681",
    "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": "231-518-0189",
            "fax_number": "231-518-0188"
        },
        {
            "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": "231-518-0189",
            "fax_number": "231-518-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARDMAN FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-10",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "KREYKES",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-624-1054",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101013379",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601002729",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Boardman, MI

Sources for this page

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