1. Home
  2. Directory
  3. Michigan
  4. Southgate
  5. Family Medicine
  6. NPI Profile

SOUTHFORT FAMILY CLINIC PC
NPI 1184801318
Family Medicine in Southgate, MI

Active since January 30, 2008
13650 FORT ST, SOUTHGATE, MI 48195(734) 281-2150 Get Directions Write a Review

NPPES record last updated: January 30, 2008. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Southfort Family Clinic Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHFORT FAMILY CLINIC PC (NPI 1184801318) is a healthcare organization registered as a family medicine in Southgate, Michigan and active in the NPI registry since January 2008. The organization lists Edward Nazareno, President, as its authorized official.

NPPES Registry Identity

NPI1184801318
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSOUTHFORT FAMILY CLINIC PC
Location Address13650 FORT STSouthgate, MI 48195-1152
Mailing Address13650 Fort StSouthgate, MI 48195-1152 · (734) 281-2150
Phone(734) 281-2150
Organization SubpartNo
Authorized OfficialEdward NazarenoPresident · (734) 281-2150
Enumeration DateJanuary 30, 2008
✔ NPI 1184801318 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MI · 4301067719
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

13650 FORT ST, Southgate, MI 48195
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D0967728

Southfort Family Clinic, PC · Southgate, MI
Expired · Nov 21, 2025
CLIA Number23D0967728
Laboratory TypePhysician Office
Certificate Effective DateNovember 22, 2023
Certificate Expiration DateNovember 21, 2025
Laboratory DirectorEdward I. Nazareno, MD
Laboratory Phone(734) 281-2150
Laboratory LocationSouthfort Family Clinic, PC13650 Fort Street, Southgate, MI 48195
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. EDWARD NAZARENO M.D.
Family Medicine
13650 FORT ST
SOUTHGATE, MI 48195
Wayne County (734) 281-2150

Frequently Asked Questions

What is SOUTHFORT FAMILY CLINIC PC's NPI number?

The NPI number assigned to this healthcare provider is 1184801318, enumerated as an "organization" on January 30, 2008.

Where is the provider located?

The provider is located at 13650 FORT ST SOUTHGATE, MI 48195 and the phone number is (734) 281-2150.

What is the provider's specialty?

Family Medicine with taxonomy code 207Q00000X.