| NPI | 1073534392 |
|---|---|
| Former Legal Business Name | EASTSIDE FAMILY MEDICAL |
| Entity Type | Organization |
| Authorized Contact | WILLIAM FREDERICK DUBOIS Owner 231-972-2710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2016-06-02 |