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Contact Information

CLINICAL PSYCHIATRIC MEDICINE PC
0-151 44TH STREET SW
GRANDVILLE, MI49418
 Phone: 616-457-1889
 Fax: 616-457-1891
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
Indicates primary specialty

NPI Profile & details for CLINICAL PSYCHIATRIC MEDICINE PC

NPI # 1386677185
LBN Legal business name CLINICAL PSYCHIATRIC MEDICINE PC
Authorized official NAN AH - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 07/08/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
MI License # 4301045669
MI Medicaid 3085001
MI Other NA045669 BLUE CROSS BLUE SHIELD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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