Provider Demographics
NPI:1164467916
Name:PINCONNING MEDICAL CENTER P.C.
Entity Type:Organization
Organization Name:PINCONNING MEDICAL CENTER P.C.
Other - Org Name:BANGOR MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-892-7722
Mailing Address - Street 1:712 S TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-4211
Mailing Address - Country:US
Mailing Address - Phone:899-684-8186
Mailing Address - Fax:989-684-8203
Practice Address - Street 1:4175 N EUCLID AVE STE 3
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2483
Practice Address - Country:US
Practice Address - Phone:899-684-8183
Practice Address - Fax:989-684-8203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINCONNING MEDICAL CENTER P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4190137Medicaid
1015890OtherMCLAREN HEALTH
MI080Z910290OtherBCBS
1015890OtherMCLAREN HEALTH