Healthcare Provider Details

I. General information

NPI: 1851328736
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 E CHICAGO ST
COLDWATER MI
49036-2041
US

IV. Provider business mailing address

274 E CHICAGO ST
COLDWATER MI
49036-2041
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number120010
License Number StateMI

VIII. Authorized Official

Name: RICHARD TRUFANT
Title or Position: CFO
Credential:
Phone: 517-279-5396