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Active NPI 1376580175 Organization (Entity Type 2)

Michael Stack Md Pc

Clinic/Center - Rural Health • Ithaca, MI

About Michael Stack Md Pc NPI 1376580175 Summary

Michael Stack Md Pc is a verified healthcare organization specializing in Clinic/Center - Rural Health operating in Ithaca, MI. Located at 121 N PINE RIVER ST, this facility provides patient care and medical services under National Provider Identifier (NPI) 1376580175.

Administrative operations and authorized compliance are overseen by Michael Stack (Owner).

The facility is associated with 5 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

121 N Pine River St

Ithaca, MI 488471039

Telephone 9898755111

Fax 9898755023

Authorized Official Information

Authorized Contact Name

DR. Michael Stack , MD

Title / Role

Owner

Official Telephone

9898755111

Facility Classifications & Specialties

Clinic/Center - Rural Health Primary Taxonomy

NUCC Taxonomy Code: 261QR1300X

Definition to come...

Family Medicine

NUCC Taxonomy Code: 207Q00000X

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.

Nurse Practitioner - Family

NUCC Taxonomy Code: 363LF0000X

Definition to come...

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

5 Linked

Matthew Stack , PA-C NPI 1033108667

Physician Assistant

Ithaca, MI

View Practitioner Profile →

Cora Pavlik , FNP NPI 1043704133

Nurse Practitioner - Family

Ithaca, MI

View Practitioner Profile →

Elizabeth Hackert-Neff , MA LPC NPI 1528210366

Counselor - Professional

Ithaca, MI

View Practitioner Profile →

Dr. Michael Stack , MD NPI 1932146685

Family Medicine

Ithaca, MI

View Practitioner Profile →

Aubree Akers , FNP NPI 1982321378

Nurse Practitioner - Family

Ithaca, MI

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events

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NPI Profile Active January 08, 2009

NPI status registered as active in NPPES database

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Updated Practice Location January 08, 2009

Registered at 121 N PINE RIVER ST, ITHACA, MI 488471039 (Tel: 9898755111)

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Updated Business Mailing Address January 08, 2009

Registered at 121 N PINE RIVER ST, ITHACA, MI 488471039 (Tel: 9898755111)

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Organization / Clinic Name Updated January 08, 2009

Operating as MICHAEL STACK MD PC

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Medical Taxonomy / Specialty Registered (Primary Specialty) January 08, 2009

Family Medicine

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Initial NPI Registration & Enumeration June 01, 2006

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1376580175

Entity Type:

Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)

Enumeration Date: June 01, 2006

Last Update: January 08, 2009

Update or Correct Listing

Mailing Address

121 N Pine River St

Ithaca, MI 488471039

Phone: 9898755111

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.

⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.