Provider Demographics
NPI:1669593901
Name:STEVEN H EDMONDSON DO, THERESE ROUSE DO & FRANK L SCHMID DO PC
Entity type:Organization
Organization Name:STEVEN H EDMONDSON DO, THERESE ROUSE DO & FRANK L SCHMID DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-642-9408
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:107 N BRIDGE ST
Mailing Address - City:SARANAC
Mailing Address - State:MI
Mailing Address - Zip Code:48881-0007
Mailing Address - Country:US
Mailing Address - Phone:616-642-9408
Mailing Address - Fax:616-642-6940
Practice Address - Street 1:107 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SARANAC
Practice Address - State:MI
Practice Address - Zip Code:48881-0007
Practice Address - Country:US
Practice Address - Phone:616-642-9408
Practice Address - Fax:616-642-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26828Medicare UPIN
MIE61971Medicare UPIN
MIOM78350001Medicare PIN
MIB43687Medicare UPIN
MIOM78350003Medicare PIN
MIOM78350002Medicare PIN