Organization
EAST BAY MEDICAL CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE ALAINE BLANCHARD NP (OWNER)
(989) 366-1515
Entity
Organization
Contact information
Practice address
1401 SHORT DR, PRUDENVILLE, MI 48651-8436
(989) 366-1515
(989) 366-1501
Mailing address
PO BOX 19, 1401 SHORT DRIVE, PRUDENVILLE, MI 48651-8436
(989) 366-1515
(989) 366-1501
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
4704203066
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4577440
—
MI
01
—
5008702190
BLUE CROSS BLUE SHIELD
MI
Enumeration date
07/10/2007
Last updated
06/12/2013
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