Provider Demographics
NPI:1851328736
Name:COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUFANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-279-5396
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 1:274 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2041
Practice Address - Country:US
Practice Address - Phone:517-279-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI120010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P08690Medicare ID - Type UnspecifiedPA GROUP