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NORTHRIDGE FAMILY PRACTICE LLC
NPI 1780803932
Internal Medicine - Clinical Cardiac Electrophysiology in Hale, MI

Active since April 25, 2007
3190 NORTHRIDGE DRIVE, HALE, MI 48739(989) 728-6000(989) 728-6003 Get Directions Write a Review

NPPES record last updated: January 13, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Northridge Family Practice Llc NPPES

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

NORTHRIDGE FAMILY PRACTICE LLC (NPI 1780803932) is a healthcare organization registered as a clinical cardiac electrophysiology in Hale, Michigan and active in the NPI registry since April 2007. The organization lists Debra Provoast, Owner, as its authorized official.

NPPES Registry Identity

NPI1780803932
Entity TypeOrganization
Primary Taxonomy207RC0001X
Legal Business NameNORTHRIDGE FAMILY PRACTICE LLC
Location Address3190 NORTHRIDGE DRIVEHale, MI 48739-9276
Mailing AddressPo Box 279Hale, MI 48739-0279 · (198) 972-8600 · Fax (989) 728-6003
Phone(989) 728-6000
Fax(989) 728-6003
Organization SubpartNo
Authorized OfficialDebra ProvoastOwner · (989) 728-6000
Enumeration DateApril 25, 2007
Last NPPES UpdateJanuary 13, 2009
✔ NPI 1780803932 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Clinical Cardiac ElectrophysiologyAllopathic & Osteopathic Physicians
Taxonomy Code207RC0001X
License✔ Licensed in MI · 5101011670
Definition
A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them.
Also ListedInternal MedicineTaxonomy 207R00000X · License 4301061417 (MI)
3190 NORTHRIDGE DRIVE, Hale, MI 48739
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Other Identifiers 10

Other080C510310MI · Bcbs Group
OtherDL074550MI · Daniel Lee
OtherMA061417MI · Mohamed Ali
Medicare UPINH22803MI
Medicare PIN0P24490004MI
Medicare UPING34770MI
Medicaid114811801MI
Medicare UPING12604MI
Medicare ID-Type Unspecified0P24490MI · Group
Medicaid104289418MI

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 MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

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

DEBRA K PROVOAST NP
Nurse Practitioner (Family)
3190 NORTHRIDGE DRIVE
HALE, MI 48739
Iosco County (989) 728-6000
BETH A WEAVER NP
Nurse Practitioner (Family)
3190 NORTHRIDGE DRIVE
HALE, MI 48739
Iosco County (989) 728-6000
NORTHRIDGE FAMILY PRACTICE LLC
Nurse Practitioner
3190 NORTHRIDGE DRIVE
HALE, MI 48739
Iosco County (989) 728-6000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northridge Family Practice LLC's NPI number?

The NPI number for Northridge Family Practice LLC is 1780803932. It was assigned to this organization in the NPPES registry on April 25, 2007.

Where is Northridge Family Practice LLC located?

Northridge Family Practice LLC is located at 3190 Northridge Drive, Hale, MI 48739. The listed phone number is (989) 728-6000.

What is Northridge Family Practice LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Clinical Cardiac Electrophysiology, with taxonomy code 207RC0001X.

When was this NPI record last updated?

The NPPES record for Northridge Family Practice LLC was last updated on January 13, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.