Provider Demographics
NPI:1598058117
Name:BATTLE CREEK COMMUNITY PHYSICIANS
Entity Type:Organization
Organization Name:BATTLE CREEK COMMUNITY PHYSICIANS
Other - Org Name:BRONSON MEDICAL GROUP BATTLE CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-245-8496
Mailing Address - Street 1:165 WASHINGTON AVE N
Mailing Address - Street 2:CENTRAL BUSINESS OFFICE
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-2929
Mailing Address - Country:US
Mailing Address - Phone:269-245-8230
Mailing Address - Fax:269-245-8251
Practice Address - Street 1:165 WASHINGTON AVE N
Practice Address - Street 2:CENTRAL BUSINESS OFFICE
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-2929
Practice Address - Country:US
Practice Address - Phone:269-245-8250
Practice Address - Fax:269-245-8251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRONSON BATTLE CREEK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-17
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5037Medicare PIN