| Beaver Island Rural Health Center | |
|
37304 Kings Hwy Beaver Island MI 49782-9792 | |
| (231) 448-2275 | |
| (231) 448-2348 |
| Full Name | Beaver Island Rural Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 37304 Kings Hwy, Beaver Island, Michigan |
| Authorized Official Name and Position | Donna Kubic (MANAGING DIRECTOR) |
| Authorized Official Contact | 2314482275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beaver Island Rural Health Center 37304 Kings Hwy Beaver Island MI 49782-9792 Ph: (231) 448-2275 | Beaver Island Rural Health Center 37304 Kings Hwy Beaver Island MI 49782-9792 Ph: (231) 448-2275 |
| NPI Number | 1407828080 |
|---|---|
| Provider Enumeration Date | 02/07/2006 |
| Last Update Date | 01/23/2013 |
| Medicare PECOS PAC ID | 3971539156 |
|---|---|
| Medicare Enrollment ID | O20050711000160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407828080 | NPI | - | NPPES |
| 1407828080 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | John D Martin |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1831128180 PECOS PAC ID: 1052206596 Enrollment ID: I20040302000775 |
| Provider Name | Cecilia L Peasley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164445524 PECOS PAC ID: 4183514250 Enrollment ID: I20040319001352 |
| Provider Name | Daniel Mathew Mann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306838081 PECOS PAC ID: 8022168079 Enrollment ID: I20100827000236 |
| Provider Name | Kelly Noel Becker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629355813 PECOS PAC ID: 3375703002 Enrollment ID: I20120404000335 |
| Provider Name | Terry L Braciszewski |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386656023 PECOS PAC ID: 5991955478 Enrollment ID: I20121017000947 |
| Provider Name | Joan A Matejovsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750857934 PECOS PAC ID: 6800140492 Enrollment ID: I20181119000431 |
| Provider Name | Brandon M Vincent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275092561 PECOS PAC ID: 9133461130 Enrollment ID: I20190423001033 |
| Provider Name | Jason John Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912345984 PECOS PAC ID: 7911136007 Enrollment ID: I20210106003197 |
| Provider Name | Tammy Radionoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245719194 PECOS PAC ID: 2163844184 Enrollment ID: I20210224001336 |
| Provider Name | Timothy King |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1215963202 PECOS PAC ID: 5395638159 Enrollment ID: I20230203001748 |