Provider Demographics
NPI:1962565895
Name:BROWNS PROFESSIONAL SERV INC
Entity type:Organization
Organization Name:BROWNS PROFESSIONAL SERV INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:517-789-8980
Mailing Address - Street 1:1410 W GANSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-4063
Mailing Address - Country:US
Mailing Address - Phone:517-789-8980
Mailing Address - Fax:517-750-2181
Practice Address - Street 1:2136 ROBINSON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3557
Practice Address - Country:US
Practice Address - Phone:517-750-2180
Practice Address - Fax:517-750-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 261QM2500X, 332B00000X, 333600000X
MI239253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962565895Medicaid