Provider Demographics
NPI:1962223453
Name:BALDWIN FAMILY HEALTH CARE
Entity type:Organization
Organization Name:BALDWIN FAMILY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-745-5482
Mailing Address - Street 1:520 COBB ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2588
Mailing Address - Country:US
Mailing Address - Phone:231-876-6527
Mailing Address - Fax:231-876-6519
Practice Address - Street 1:351 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT CITY
Practice Address - State:MI
Practice Address - Zip Code:49330-9110
Practice Address - Country:US
Practice Address - Phone:616-678-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALDWIN FAMILY HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)