=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962507608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH CENTERS INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 N STATE ST
-----------------------------------------------------
City | GOBLES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49055-9717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-628-2196
-----------------------------------------------------
Fax | 269-628-2363
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 N STATE ST PO BOX 280
-----------------------------------------------------
City | GOBLES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49055-9717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-628-2196
-----------------------------------------------------
Fax | 269-628-2363
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. LINDA I ODELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-628-6086
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------