Provider Demographics
NPI:1003990201
Name:HPCN
Entity Type:Organization
Organization Name:HPCN
Other - Org Name:BEAR CREEK HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-1678
Mailing Address - Street 1:1877 N GETTY ST
Mailing Address - Street 2:
Mailing Address - City:N MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-8563
Mailing Address - Country:US
Mailing Address - Phone:231-728-5073
Mailing Address - Fax:231-728-5086
Practice Address - Street 1:1877 N GETTY ST
Practice Address - Street 2:
Practice Address - City:N MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-8563
Practice Address - Country:US
Practice Address - Phone:231-728-5073
Practice Address - Fax:231-728-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072876207Q00000X
MI4301077504207Q00000X
MI4301060189207Q00000X
MI4301039064207R00000X
MI4301063121207R00000X
MI4301077595207R00000X
MI4301080510207R00000X
MI43010085193207R00000X
MI5601002357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11OF110940OtherBCBS GROUP NUMBER
MI=========OtherTAX ID
MI=========OtherTAX ID
0N79560Medicare PIN