Provider Demographics
NPI:1730419888
Name:BATTISTE FAMILY MEDICINE PLC
Entity type:Organization
Organization Name:BATTISTE FAMILY MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:HARMON
Authorized Official - Last Name:BATTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-583-0958
Mailing Address - Street 1:7125 KRAFT AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9402
Mailing Address - Country:US
Mailing Address - Phone:616-583-0958
Mailing Address - Fax:616-583-0961
Practice Address - Street 1:7125 KRAFT AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9402
Practice Address - Country:US
Practice Address - Phone:616-583-0958
Practice Address - Fax:616-583-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2398Medicare PIN