Healthcare Provider Details

I. General information

NPI: 1962223453
Provider Name (Legal Business Name): BALDWIN FAMILY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 N MAIN ST
KENT CITY MI
49330-9110
US

IV. Provider business mailing address

520 COBB ST
CADILLAC MI
49601-2588
US

V. Phone/Fax

Practice location:
  • Phone: 616-678-6002
  • Fax:
Mailing address:
  • Phone: 231-876-6527
  • Fax: 231-876-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JULIE TATKO
Title or Position: CEO
Credential:
Phone: 231-745-5482