Healthcare Provider Details

I. General information

NPI: 1619304458
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N FREMONT ST
COLDWATER MI
49036-1206
US

IV. Provider business mailing address

274 E CHICAGO ST
COLDWATER MI
49036-2041
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-5295
  • Fax:
Mailing address:
  • Phone: 517-279-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDALL DEGROOT
Title or Position: PRESIDENT/CEO
Credential:
Phone: 517-279-5489