Provider Demographics
NPI:1679642599
Name:BATTLE CREEK MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:BATTLE CREEK MEDICAL ASSOCIATES, PC
Other - Org Name:SENIOR DIAGNOSTIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRK031921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1202010Medicaid
MI4595108Medicaid
MI1786886Medicaid
MI2738542Medicaid
MI1202010Medicaid
MIR64799Medicare UPIN
MI0M87660Medicare ID - Type UnspecifiedJEANNE HICKMAN
MI0M82070Medicare ID - Type UnspecifiedMARTHA BOYER
MI2738542Medicaid
MIH19796Medicare UPIN
MII10674Medicare UPIN
MIA77129Medicare UPIN
MI4595108Medicaid