Provider Demographics
NPI:1447380324
Name:CLARENCE RICHARD BARNETT MD PLC
Entity Type:Organization
Organization Name:CLARENCE RICHARD BARNETT MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-374-8881
Mailing Address - Street 1:1020 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ODESSA
Mailing Address - State:MI
Mailing Address - Zip Code:48849-1004
Mailing Address - Country:US
Mailing Address - Phone:616-374-8881
Mailing Address - Fax:616-374-4220
Practice Address - Street 1:1020 4TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-1004
Practice Address - Country:US
Practice Address - Phone:616-374-8881
Practice Address - Fax:616-374-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICB047150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI135OtherPRIORITY HEALTH
MA200000001213OtherPHYSICIANS HEALTH PLAN
MI0340028OtherBCBS
MI4847930Medicaid
MA200000001213OtherPHYSICIANS HEALTH PLAN
MI135OtherPRIORITY HEALTH
MA0P30100Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER