Provider Demographics
NPI:1467826206
Name:COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Other - Org Name:CHC FAMILY PRACTICE OF BRONSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGROOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:527-279-5489
Mailing Address - Street 1:197 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:MI
Mailing Address - Zip Code:49028-1213
Mailing Address - Country:US
Mailing Address - Phone:517-369-2506
Mailing Address - Fax:
Practice Address - Street 1:197 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:MI
Practice Address - Zip Code:49028-1213
Practice Address - Country:US
Practice Address - Phone:517-369-2506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty