Organization
CENTER FOR FAMILY HEALTH
Active
Organization
CENTER FOR FAMILY HEALTH
Active
Other names
Teen Center at Parkside
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE MAYO (PATIENT ACCOUNTS.MANAGER)
(517) 748-5500
Entity
Organization
Contact information
Practice address
2400 4TH ST, JACKSON, MI 49203-4573
(517) 788-6812
(517) 788-7722
Mailing address
505 N JACKSON ST, JACKSON, MI 49201-1266
(517) 748-5500
(517) 780-9286
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
MI
1041S0200X
School Social Worker
—
MI
207Q00000X
Family Medicine Physician
—
MI
207R00000X
Internal Medicine Physician
—
MI
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500C807070
BCBSM GROUP NUMBER
MI
01
—
700C810070
BCBSM GROUP PROVIDER
MI
Enumeration date
11/09/2006
Last updated
02/10/2022
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