Provider Demographics
NPI:1518159169
Name:ELLA E M BROWN CHARITABLE CIRCLE
Entity Type:Organization
Organization Name:ELLA E M BROWN CHARITABLE CIRCLE
Other - Org Name:OAKLAWN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL PLANNING & REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-781-4271
Mailing Address - Street 1:300 B DR N
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-8420
Mailing Address - Country:US
Mailing Address - Phone:517-629-2134
Mailing Address - Fax:
Practice Address - Street 1:420 S HILLSDALE ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:MI
Practice Address - Zip Code:49245-1248
Practice Address - Country:US
Practice Address - Phone:517-568-4481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI233974Medicare Oscar/Certification
0N82970Medicare PIN