Provider Demographics
NPI:1700329521
Name:BALDWIN FAMILY HEALTH CARE
Entity Type:Organization
Organization Name:BALDWIN FAMILY HEALTH CARE
Other - Org Name:PINE RIVER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-745-2743
Mailing Address - Street 1:1615 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MI
Mailing Address - Zip Code:49304-7984
Mailing Address - Country:US
Mailing Address - Phone:231-745-2743
Mailing Address - Fax:231-745-5031
Practice Address - Street 1:17445 PINE RIVER RD
Practice Address - Street 2:
Practice Address - City:LEROY
Practice Address - State:MI
Practice Address - Zip Code:49655
Practice Address - Country:US
Practice Address - Phone:231-829-3841
Practice Address - Fax:231-829-9030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALDWIN FAMILY HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-28
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D36000OtherBCBS GROUP ID
MI0D36000OtherBCBS GROUP ID