Provider Demographics
NPI:1639116494
Name:PINCONNING MEDICAL CENTER P.C.
Entity type:Organization
Organization Name:PINCONNING MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-892-7722
Mailing Address - Street 1:712 S TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-4211
Mailing Address - Country:US
Mailing Address - Phone:899-684-8183
Mailing Address - Fax:899-684-8203
Practice Address - Street 1:204 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PINCONNING
Practice Address - State:MI
Practice Address - Zip Code:48650-9622
Practice Address - Country:US
Practice Address - Phone:989-879-3771
Practice Address - Fax:989-879-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QR1300X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1083930663OtherNPI
MI080Z910290OtherBCBS
MI1012455OtherMCLAREN
MI4279897Medicaid
MI010Z900580OtherBCBS GROUP
MI0Z90058OtherBCBS GROUP
MI0Z90055OtherBCBS PA GROUP
MIN11800010Medicare UPIN
MI0N11800Medicare ID - Type Unspecified
MI0Z90055OtherBCBS PA GROUP
MI0N11800Medicare PIN