Provider Demographics
NPI:1104922863
Name:THE DOCTORS GROUP, PC
Entity type:Organization
Organization Name:THE DOCTORS GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARB
Authorized Official - Middle Name:C
Authorized Official - Last Name:VANHAITSMA
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:269-969-4656
Mailing Address - Street 1:1125 MICHIGAN AVE E
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-6832
Mailing Address - Country:US
Mailing Address - Phone:269-969-4656
Mailing Address - Fax:269-969-6085
Practice Address - Street 1:1125 MICHIGAN AVE E
Practice Address - Street 2:SUITE 5
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-6832
Practice Address - Country:US
Practice Address - Phone:269-969-4656
Practice Address - Fax:269-969-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083010261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4227952Medicaid
MI4635366Medicaid
MI4300678Medicaid
MI0N25600Medicare PIN
MI4227952Medicaid
MI4300678Medicaid
MIH3297Medicare UPIN