Healthcare Provider Details

I. General information

NPI: 1295807741
Provider Name (Legal Business Name): PARCHMENT FAMILY PRACTICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 E G AVE
PARCHMENT MI
49004-1943
US

IV. Provider business mailing address

2350 E G AVE
PARCHMENT MI
49004-1943
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-6183
  • Fax: 269-349-3046
Mailing address:
  • Phone: 269-344-6183
  • Fax: 269-349-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101011220
License Number StateMI

VIII. Authorized Official

Name: DR. ERIC E BORN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 269-344-6173