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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