NPIMap

Organization Active NPI

Gladwin Family Care Center

  • Specialist
  • Gladwin, MI
National Provider Identifier
1922330851
Registry record updated Feb 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
4301080387 Issued in MI
Legal business name
GLADWIN FAMILY CARE CENTER
Practice address
2137 W M 61
Gladwin, MI 48624-8463
Phone
(989) 426-9399
Fax
(989) 246-2257
NPI assigned
Feb 3, 2010
Last updated
Feb 3, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2010

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

Authorized official

Name
Tarek Mustapha Ezzeddine, MD
Title
Owner
Phone
(989) 426-9399

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 4301080387 MI Primary

Addresses

Primary practice location

2137 W M 61
Gladwin, MI 48624-8463

Mailing address

2137 W M 61
Gladwin, MI 48624-8463
Phone (989) 426-9399

National Provider Directory

National Provider Directory
Tax ID family
Gladwin Family Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17512/brand/1/csg/1/fhir/r4

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": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265155200000",
    "number": "1922330851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2137 W M 61",
            "city": "GLADWIN",
            "state": "MI",
            "postal_code": "486248463",
            "telephone_number": "989-426-9399",
            "fax_number": "989-246-2257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2137 W M 61",
            "city": "GLADWIN",
            "state": "MI",
            "postal_code": "486248463",
            "telephone_number": "989-426-9399",
            "fax_number": "989-246-2257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLADWIN FAMILY CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-03",
        "last_updated": "2010-02-03",
        "status": "A",
        "authorized_official_last_name": "EZZEDDINE",
        "authorized_official_first_name": "TAREK",
        "authorized_official_middle_name": "MUSTAPHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-426-9399",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301080387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gladwin, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; 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.