Provider Demographics
NPI:1225270002
Name:WEST BRANCH FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:WEST BRANCH FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-516-4317
Mailing Address - Street 1:959 WEST M-61
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9307
Mailing Address - Country:US
Mailing Address - Phone:989-516-4317
Mailing Address - Fax:989-345-5803
Practice Address - Street 1:611 COURT STREET
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-0903
Practice Address - Country:US
Practice Address - Phone:989-516-4317
Practice Address - Fax:989-345-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty