Provider Demographics
NPI:1235141979
Name:BATTLE CREEK FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:BATTLE CREEK FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ASBURY
Authorized Official - Last Name:WALK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-969-6000
Mailing Address - Street 1:126 COLLEGE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3461
Mailing Address - Country:US
Mailing Address - Phone:269-969-6000
Mailing Address - Fax:269-963-1522
Practice Address - Street 1:126 COLLEGE ST
Practice Address - Street 2:SUITE A
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3461
Practice Address - Country:US
Practice Address - Phone:269-969-6000
Practice Address - Fax:269-963-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046717207Q00000X
MI4301084400207R00000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A31131OtherBCBS GROUP PIN
MIOM44700Medicare ID - Type Unspecified