Provider Demographics
NPI:1295807741
Name:PARCHMENT FAMILY PRACTICE, P.C.
Entity type:Organization
Organization Name:PARCHMENT FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:BORN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-344-6173
Mailing Address - Street 1:2350 E G AVE
Mailing Address - Street 2:
Mailing Address - City:PARCHMENT
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1943
Mailing Address - Country:US
Mailing Address - Phone:269-344-6183
Mailing Address - Fax:269-349-3046
Practice Address - Street 1:2350 E G AVE
Practice Address - Street 2:
Practice Address - City:PARCHMENT
Practice Address - State:MI
Practice Address - Zip Code:49004-1943
Practice Address - Country:US
Practice Address - Phone:269-344-6183
Practice Address - Fax:269-349-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114621039Medicaid
0P38930Medicare PIN
MIE92642Medicare UPIN