Provider Demographics
NPI:1578612735
Name:ELLA E M BROWN CHARITABLE CIRCLE
Entity Type:Organization
Organization Name:ELLA E M BROWN CHARITABLE CIRCLE
Other - Org Name:OAKLAWN MEDICAL GROUP HOMER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:BEEG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-781-4271
Mailing Address - Street 1:200 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1143
Mailing Address - Country:US
Mailing Address - Phone:269-781-4271
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:517-568-3720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103118050Medicaid
MI16004OtherBCBS OF MICHIGAN FACILITY PIN
MI233974Medicare Oscar/Certification
MI0N82970003Medicare PIN
MI0M09700Medicare PIN