=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164467916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINCONNING MEDICAL CENTER P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2006
-----------------------------------------------------
Last Update Date | 06/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4175 N EUCLID AVE STE 3
-----------------------------------------------------
City | BAY CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48706-2483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 899-684-8183
-----------------------------------------------------
Fax | 989-684-8203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 712 S TRUMBULL ST
-----------------------------------------------------
City | BAY CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48708-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 899-684-8186
-----------------------------------------------------
Fax | 989-684-8203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC ADMINISTRATOR
-----------------------------------------------------
Name | MR. WILLIAM E BERNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-892-7722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------