Provider Demographics
NPI:1962595546
Name:CHARLES R BARKER JR DO FAMILY PRACTICE PC
Entity type:Organization
Organization Name:CHARLES R BARKER JR DO FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-794-1810
Mailing Address - Street 1:1320 W STATE STREET
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-9245
Mailing Address - Country:US
Mailing Address - Phone:616-794-1810
Mailing Address - Fax:616-794-1947
Practice Address - Street 1:1320 W STATE ST
Practice Address - Street 2:STE 3A
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-9245
Practice Address - Country:US
Practice Address - Phone:616-794-1810
Practice Address - Fax:616-794-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICB013251207QS0010X
MI5101013251261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4569538Medicaid
MIH27528Medicare UPIN
MI238917Medicare Oscar/Certification