Provider Demographics
NPI:1174759989
Name:ADULT INTERNAL MEDICINE AND FAMILY CARE, PLC
Entity type:Organization
Organization Name:ADULT INTERNAL MEDICINE AND FAMILY CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIBB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-541-1000
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-0367
Mailing Address - Country:US
Mailing Address - Phone:517-485-0001
Mailing Address - Fax:
Practice Address - Street 1:134 S COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1557
Practice Address - Country:US
Practice Address - Phone:517-541-1000
Practice Address - Fax:517-541-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B30018OtherBCBSM
MI0B30018OtherBCBSM