NPI Lookup
NPI Lookup from the NPI Registry — National Provider Identifier Database

Contact Information

20TH STREET CLINIC PC
105 N 20TH ST
BATTLE CREEK, MI49015-1746
 Phone: 269-969-6010
 Fax: 269-964-8422
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for 20TH STREET CLINIC PC

NPI # 1578744918
LBN Legal business name 20TH STREET CLINIC PC
Authorized official STEPHEN FEDELE - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/14/2007
Last updated 03/27/2013 - About 6 years ago
Identifiers
MI License # 5101004673
MI Medicaid 111023860
Other 5130499 MEDICARE ADVANTAGE
Other CJ8333 RR MCR
Other 010057408 RR MCR P-TAN
MI Other 464295 ADVANTRA FREEDOM
MI Other 080A310650 BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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