1598058117 NPI number — BATTLE CREEK COMMUNITY PHYSICIANS

Table of content: (NPI 1598058117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598058117 NPI number — BATTLE CREEK COMMUNITY PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BATTLE CREEK COMMUNITY PHYSICIANS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRONSON MEDICAL GROUP BATTLE CREEK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598058117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 WASHINGTON AVE N
Provider Second Line Business Mailing Address:
CENTRAL BUSINESS OFFICE
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49037-2929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-245-8230
Provider Business Mailing Address Fax Number:
269-245-8251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 WASHINGTON AVE N
Provider Second Line Business Practice Location Address:
CENTRAL BUSINESS OFFICE
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49037-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-245-8250
Provider Business Practice Location Address Fax Number:
269-245-8251
Provider Enumeration Date:
05/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
269-245-8496

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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