Provider Demographics
NPI:1619026887
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 1:200 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 1:300 B DR N
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-8420
Practice Address - Country:US
Practice Address - Phone:517-629-2134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDA0352OtherRAILROAD MEDICARE GROUP
MI0A36020OtherBLUE CROSS BLUE SHIELD
MI0A37669OtherBCBSM
MI0A37669OtherBCBSM