1396135927 NPI number — COMPREHENSIVE MEDICAL CARE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396135927 NPI number — COMPREHENSIVE MEDICAL CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE MEDICAL CARE PC
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:
Provider Other Organization Name Type Code:
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:
1396135927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 CAPITAL AVE SW
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49015-9393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-441-1000
Provider Business Mailing Address Fax Number:
269-441-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 CAPITAL AVE SW
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49015-9393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-441-1000
Provider Business Practice Location Address Fax Number:
269-441-1002
Provider Enumeration Date:
02/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BHAN
Authorized Official First Name:
RAAKESH
Authorized Official Middle Name:
CHANDRA
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
269-441-1000

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  4301048458 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2792609 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: OM76510002 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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