Healthcare Provider Details

I. General information

NPI: 1831421528
Provider Name (Legal Business Name): THE FAMIILY PRACTICE AND ORTHOPEDIC CARE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N WILLOWBROOK RD
COLDWATER MI
49036-9462
US

IV. Provider business mailing address

410 N WILLOWBROOK RD
COLDWATER MI
49036-9462
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-9599
  • Fax: 517-279-1679
Mailing address:
  • Phone: 517-279-9599
  • Fax: 517-279-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101014488
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501011233
License Number StateMI

VIII. Authorized Official

Name: MR. RICHARD J HARTMAN JR.
Title or Position: PRESIDENT
Credential: D.O.
Phone: 517-279-9599