Organization
BEAVERTON MEDICAL CENTER P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM E BERNER (CLINIC ADMINISTRATOR)
(989) 892-7722
Entity
Organization
Contact information
Practice address
129 W BROWN ST, BEAVERTON, MI 48612-8119
(989) 435-2937
(989) 435-3121
Mailing address
1003 WOODSIDE AVE, ESSEXVILLE, MI 48732-1234
(989) 892-7722
(989) 892-7455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104176826
—
MI
01
—
O80B610040
BCBS
MI
Enumeration date
06/18/2006
Last updated
07/28/2014
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