Provider Demographics
NPI:1053307611
Name:BAYBROOK MEDICAL CENTER
Entity Type:Organization
Organization Name:BAYBROOK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARIE
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BLEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-354-7666
Mailing Address - Street 1:1691 M 32 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-8210
Mailing Address - Country:US
Mailing Address - Phone:989-354-7666
Mailing Address - Fax:989-354-7595
Practice Address - Street 1:1691 M 32 W
Practice Address - Street 2:SUITE 300
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-8210
Practice Address - Country:US
Practice Address - Phone:989-354-7666
Practice Address - Fax:989-354-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010Z40570OtherBLUE CROSS BLUE SHIELD OF MI
MI4286318Medicaid
MI4286318Medicaid