Provider Demographics
NPI:1699960013
Name:SELECT HEALTH, P.C.
Entity type:Organization
Organization Name:SELECT HEALTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:517-278-6600
Mailing Address - Street 1:436 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1139
Mailing Address - Country:US
Mailing Address - Phone:517-278-6600
Mailing Address - Fax:517-278-0600
Practice Address - Street 1:436 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1139
Practice Address - Country:US
Practice Address - Phone:517-278-6600
Practice Address - Fax:517-278-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639129646Medicaid
MI1821054966Medicaid
MI1144262122Medicaid
MII48238Medicare UPIN
MI1144262122Medicaid