Healthcare Provider Details

I. General information

NPI: 1063961738
Provider Name (Legal Business Name): BELLEVILLE FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OWEN ST
BELLEVILLE MI
48111-2921
US

IV. Provider business mailing address

25 OWEN ST
BELLEVILLE MI
48111-2921
US

V. Phone/Fax

Practice location:
  • Phone: 734-699-5400
  • Fax: 734-699-5455
Mailing address:
  • Phone: 734-699-5400
  • Fax: 734-699-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704164057
License Number StateMI

VIII. Authorized Official

Name: MS. JEAN PINKARD
Title or Position: ADMINISTRATOR
Credential: FNP-C
Phone: 734-699-5400