Provider Demographics
NPI:1902308463
Name:BALDWIN FAMILY HEALTH CARE
Entity Type:Organization
Organization Name:BALDWIN FAMILY HEALTH CARE
Other - Org Name:BALDWIN FAMILY HEATLH CARE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
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:231-745-2743
Mailing Address - Street 1:1615 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MI
Mailing Address - Zip Code:49304-7984
Mailing Address - Country:US
Mailing Address - Phone:231-745-2743
Mailing Address - Fax:231-745-5031
Practice Address - Street 1:1101 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MI
Practice Address - Zip Code:49304
Practice Address - Country:US
Practice Address - Phone:231-745-4624
Practice Address - Fax:231-745-5031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALDWIN FAMILY HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-01
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D36000OtherBSBSM