Provider Demographics
NPI:1790894988
Name:WEST BRANCH PULMONARY CLINIC PC
Entity Type:Organization
Organization Name:WEST BRANCH PULMONARY CLINIC PC
Other - Org Name:WEST BRANCH PULMONARY & SLEEP CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-564-9270
Mailing Address - Street 1:780 N GAVORD RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MI
Mailing Address - Zip Code:48659-9703
Mailing Address - Country:US
Mailing Address - Phone:989-654-2168
Mailing Address - Fax:989-654-2825
Practice Address - Street 1:780 N GAVORD RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MI
Practice Address - Zip Code:48659-9703
Practice Address - Country:US
Practice Address - Phone:989-654-2168
Practice Address - Fax:989-654-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITM0009037174400000X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1007603OtherMCLAREN HEALTH PLAN
MI115651012OtherBLUE CROSS BLUE SHIELD M
MI4261168Medicaid
MI4509887OtherAETNA
MI1007603OtherMCLAREN HEALTH ADVANTAGE
MI122278OtherPREFERRED CHOICE PPO
MI110216075OtherRR MEDICARE
MI115651012OtherBLUE CARE NETWORK
MI1679561443OtherNPI
MI54 0 F5 10350OtherBLUE CROSS BLUE SHIELD DM
MI110216075OtherRR MEDICARE
MI1679561443OtherNPI
MI=========OtherPRIORITY HEALTH
MI0P12870Medicare PIN