Provider Demographics
NPI:1871685511
Name:PHYSICIANS CENTER OF PHYSICAL MEDICINE P.C.
Entity Type:Organization
Organization Name:PHYSICIANS CENTER OF PHYSICAL MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLEMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-372-7200
Mailing Address - Street 1:2545 CAPITAL AVE SW STE 201
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7103
Mailing Address - Country:US
Mailing Address - Phone:269-350-2213
Mailing Address - Fax:
Practice Address - Street 1:2545 CAPITAL AVE SW STE 201
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7103
Practice Address - Country:US
Practice Address - Phone:269-979-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
MI208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2891670Medicaid
MI1824978Medicaid
MI1832998Medicaid
MI2891643Medicaid
0M01770Medicare ID - Type Unspecified
F34998Medicare UPIN
MI2891643Medicaid
MI2891670Medicaid
D83154Medicare UPIN