Healthcare Provider Details

I. General information

NPI: 1518338359
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 N CHICAGO ST
LITCHFIELD MI
49252-9792
US

IV. Provider business mailing address

413 N CHICAGO ST
LITCHFIELD MI
49252-9792
US

V. Phone/Fax

Practice location:
  • Phone: 517-542-3217
  • Fax:
Mailing address:
  • Phone: 517-542-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDY DEGROOT
Title or Position: PRESIDENT & CEO
Credential:
Phone: 517-279-5489