Provider Demographics
NPI: | 1619304458 |
---|---|
Name: | COMMUNITY HEALTH CENTER OF BRANCH COUNTY |
Entity Type: | Organization |
Organization Name: | COMMUNITY HEALTH CENTER OF BRANCH COUNTY |
Other - Org Name: | CHC CARDINAL CONNECT |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RANDALL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DEGROOT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 517-279-5489 |
Mailing Address - Street 1: | 274 E CHICAGO ST |
Mailing Address - Street 2: | |
Mailing Address - City: | COLDWATER |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 49036-2041 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 517-279-5400 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 275 N FREMONT ST |
Practice Address - Street 2: | |
Practice Address - City: | COLDWATER |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49036-1206 |
Practice Address - Country: | US |
Practice Address - Phone: | 517-279-5295 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-10-10 |
Last Update Date: | 2018-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | Group - Multi-Specialty |