MEDICARE: BEAVERTON MEDICAL CENTER P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	O80B610040	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1649215211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVERTON MEDICAL CENTER P.C.

Provider Business Mailing Address
First Line	:	1003 WOODSIDE AVE
Second Line	:
City	:	ESSEXVILLE
State	:	MI
Zip	:	48732-1234
Country	:	US
Telephone Number	:	989-892-7722
Fax Number	:	989-892-7455

Provider Business Practice Location Address
First Line	:	129 W BROWN ST
Second Line	:
City	:	BEAVERTON
State	:	MI
Zip	:	48612-8119
Country	:	US
Telephone Number	:	989-435-2937
Fax Number	:	989-435-3121

Authorized Official
Title or Position	:	CLINIC ADMINISTRATOR
Name	:	MR. WILLIAM E BERNER
Credential	:
Telephone Number	:	989-892-7722

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	07/28/2014

Similar Medicare Providers

1760424972 — MR. RICHARD A CALL PA-C
Practice Location Address:

129 W BROWN ST
BEAVERTON, MI
48612-8119

Practice Phone: 989-435-2937
Practice Fax: 989-435-3121

1497844047 — THE BEAVERTON PHARMACY INC
Practice Location Address:

127 W BROWN ST
BEAVERTON, MI
48612-8119

Practice Phone: 989-435-7778
Practice Fax: 989-435-2581

1114001781 — MR. ROBERT RIFFERT RPH
Practice Location Address:

127 W BROWN ST , PO 575
BEAVERTON, MI
48612-8119

Practice Phone: 989-435-7778
Practice Fax: 989-435-2581

1346329448 — DR. CHRISTIAN VINCENT RIFFERT PHARM.D., RPH
Practice Location Address:

127 W BROWN ST
BEAVERTON, MI
48612-8119

Practice Phone: 989-435-7778
Practice Fax: 989-435-2581

1952858987 — FAMILY HEALTH & WELLNESS PC
Practice Location Address:

129 W BROWN ST
BEAVERTON, MI
48612-8119

Practice Phone: 989-435-2937
Practice Fax: 989-435-3121

1285182899 — FAMILY HEALTH & WELLNESS P.C.
Practice Location Address:

129 W BROWN ST
BEAVERTON, MI
48612-8119

Practice Phone: 989-435-2937
Practice Fax: 989-892-7455

Directions to “BEAVERTON MEDICAL CENTER P.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.