Provider Demographics
NPI:1578730321
Name:BCHS NORTH AVENUE
Entity Type:Organization
Organization Name:BCHS NORTH AVENUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-969-6145
Mailing Address - Street 1:632 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3249
Mailing Address - Country:US
Mailing Address - Phone:269-969-6145
Mailing Address - Fax:269-969-6133
Practice Address - Street 1:632 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3249
Practice Address - Country:US
Practice Address - Phone:269-969-6145
Practice Address - Fax:269-969-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB057402207R00000X
MITP068448207R00000X
MIRK031921207RG0300X
MISA075754207RG0300X
MIMB137196363LA2200X
MIVK211652363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3486029Medicaid
MI4935881Medicaid
MI1202010Medicaid
MI1202010Medicaid
MIH19796Medicare PIN
MIQ64557Medicare UPIN
MI4935881Medicaid