| Intercare Community Health Network | |
|
50 Industrial Park Dr Bangor MI 49013 | |
| (269) 427-7937 | |
| (269) 427-5180 |
| Full Name | Intercare Community Health Network |
|---|---|
| Speciality | Clinic/Center |
| Location | 50 Industrial Park Dr, Bangor, Michigan |
| Authorized Official Name and Position | Velma Hendershott (PRESIDENT CEO) |
| Authorized Official Contact | 2694277937 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intercare Community Health Network 50 Industrial Park Dr Bangor MI 49013 Ph: (269) 427-7937 | Intercare Community Health Network 50 Industrial Park Dr Bangor MI 49013 Ph: (269) 427-7937 |
| NPI Number | 1326058512 |
|---|---|
| Provider Enumeration Date | 08/09/2006 |
| Last Update Date | 03/19/2014 |
| Medicare PECOS PAC ID | 9537061254 |
|---|---|
| Medicare Enrollment ID | O20040223000150 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326058512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | John L Bard |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1154358331 PECOS PAC ID: 9830091115 Enrollment ID: I20040126000876 |
| Provider Name | Mark E Obrien |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841221348 PECOS PAC ID: 1355237975 Enrollment ID: I20040223000279 |
| Provider Name | William L Wilkinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366473811 PECOS PAC ID: 4284624412 Enrollment ID: I20040518000466 |
| Provider Name | Sonya Lee Christensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649208786 PECOS PAC ID: 8729051412 Enrollment ID: I20040819000970 |
| Provider Name | Susan Hosana Dilan Szanto |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871520460 PECOS PAC ID: 3375510985 Enrollment ID: I20040914000199 |
| Provider Name | Peter K Christensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720007834 PECOS PAC ID: 7810957453 Enrollment ID: I20041018000589 |
| Provider Name | Lana J Zarlenga |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427088863 PECOS PAC ID: 0840258216 Enrollment ID: I20050103000030 |
| Provider Name | Lisa M Fink |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558303958 PECOS PAC ID: 6709844178 Enrollment ID: I20050103000067 |
| Provider Name | Francine M Bruder |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912261553 PECOS PAC ID: 1759339047 Enrollment ID: I20050104000095 |
| Provider Name | Bruce C Springer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871567735 PECOS PAC ID: 8820983299 Enrollment ID: I20050114000349 |
| Provider Name | Mary C Ball |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801888938 PECOS PAC ID: 2961436969 Enrollment ID: I20050920000422 |
| Provider Name | Samraja Emerson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235165093 PECOS PAC ID: 0244256048 Enrollment ID: I20051020000948 |
| Provider Name | Lisa Marshall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104871169 PECOS PAC ID: 3274533815 Enrollment ID: I20070105000243 |
| Provider Name | Kenneth P Forsman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255312047 PECOS PAC ID: 7719879246 Enrollment ID: I20070111000539 |
| Provider Name | David A Puzycki |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952478281 PECOS PAC ID: 2062413560 Enrollment ID: I20070126000103 |
| Provider Name | Mark Harrison |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1346278108 PECOS PAC ID: 4789597055 Enrollment ID: I20071023000328 |
| Provider Name | Sachchidanand Jha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295709863 PECOS PAC ID: 5092893958 Enrollment ID: I20080418000102 |
| Provider Name | Tracy M Mcintyre Anderson |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1801056726 PECOS PAC ID: 9032285812 Enrollment ID: I20080904000201 |
| Provider Name | Sunny S Tumangday |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386805778 PECOS PAC ID: 2466529375 Enrollment ID: I20080918000331 |
| Provider Name | David E Collins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326079823 PECOS PAC ID: 3678637915 Enrollment ID: I20090130000408 |
| Provider Name | Rebecca J Burnau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538482237 PECOS PAC ID: 3072647353 Enrollment ID: I20100823000843 |
| Provider Name | John G Maccart |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396892634 PECOS PAC ID: 0941193932 Enrollment ID: I20100914000034 |
| Provider Name | Charlotte Lofgren |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154529436 PECOS PAC ID: 6507054269 Enrollment ID: I20101221001161 |
| Provider Name | Michael G Jaskiewicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952591570 PECOS PAC ID: 6507049525 Enrollment ID: I20110328000831 |
| Provider Name | Pamela C Pappas |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1396753984 PECOS PAC ID: 3274717681 Enrollment ID: I20110408000701 |
| Provider Name | William Parks |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1831316306 PECOS PAC ID: 6608050885 Enrollment ID: I20110413000168 |
| Provider Name | Kami G Palmer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669672762 PECOS PAC ID: 5597943779 Enrollment ID: I20110617000631 |
| Provider Name | William T Mccadie |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1669414736 PECOS PAC ID: 9638174006 Enrollment ID: I20110801000390 |
| Provider Name | Roberta Dischinger Smedes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750578407 PECOS PAC ID: 9537330196 Enrollment ID: I20110913000104 |
| Provider Name | Terri Duran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134266638 PECOS PAC ID: 6800859794 Enrollment ID: I20110913000131 |
| Provider Name | Dave S Boparai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124284633 PECOS PAC ID: 9830360940 Enrollment ID: I20110921000810 |
| Provider Name | Jeffery J Libra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619009826 PECOS PAC ID: 1355516360 Enrollment ID: I20111202000117 |
| Provider Name | Robert E Dempsey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942271390 PECOS PAC ID: 0648356337 Enrollment ID: I20111206000748 |
| Provider Name | Megan W Danielson |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1871849877 PECOS PAC ID: 8022267095 Enrollment ID: I20121008000089 |
| Provider Name | Carolyn A Burke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477707206 PECOS PAC ID: 4082865522 Enrollment ID: I20121110000182 |
| Provider Name | Heather R Figueroa |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1518120625 PECOS PAC ID: 1153572029 Enrollment ID: I20121127000609 |
| Provider Name | Stephanie M Slye |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649356379 PECOS PAC ID: 2365623949 Enrollment ID: I20130107000219 |
| Provider Name | Stephen J Warnick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235336991 PECOS PAC ID: 4688827314 Enrollment ID: I20130109000201 |
| Provider Name | Amy Lalick |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1497798292 PECOS PAC ID: 0749433084 Enrollment ID: I20130116000546 |
| Provider Name | Steven J Debbink |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1215910559 PECOS PAC ID: 4486808474 Enrollment ID: I20130128000422 |
| Provider Name | Dustin J Hall |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437353935 PECOS PAC ID: 4284805722 Enrollment ID: I20130727000080 |
| Provider Name | David A Perez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346551082 PECOS PAC ID: 8325285315 Enrollment ID: I20130911000097 |
| Provider Name | David O Malaka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548568066 PECOS PAC ID: 5698919629 Enrollment ID: I20130913000172 |
| Provider Name | Alissa M Conklin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437318953 PECOS PAC ID: 3375708423 Enrollment ID: I20131115001708 |
| Provider Name | Benjamin T Wood |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1093904468 PECOS PAC ID: 6305014846 Enrollment ID: I20131121001259 |
| Provider Name | Miguel E Bermeo |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1811167216 PECOS PAC ID: 7810074325 Enrollment ID: I20140103000381 |
| Provider Name | Michael W Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922424993 PECOS PAC ID: 3577788694 Enrollment ID: I20140703001852 |
| Provider Name | Barbara Frederick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932516515 PECOS PAC ID: 7315192184 Enrollment ID: I20140801001225 |
| Provider Name | Robert J Hiddema |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1588748198 PECOS PAC ID: 7810116316 Enrollment ID: I20140916000749 |
| Provider Name | Crystal D Payton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639594054 PECOS PAC ID: 6800017302 Enrollment ID: I20141027001939 |
| Provider Name | Matthew A Veenstra |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1477854222 PECOS PAC ID: 7517289515 Enrollment ID: I20141202001525 |
| Provider Name | Teresa M Ansinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891185765 PECOS PAC ID: 1850610577 Enrollment ID: I20150430002519 |
| Provider Name | Angela J Dejonge Meraz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841550985 PECOS PAC ID: 6709199938 Enrollment ID: I20150717000477 |
| Provider Name | Ashley Dupuis |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1821396599 PECOS PAC ID: 5991019986 Enrollment ID: I20150804006069 |
| Provider Name | Kathryn Kern |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1487021481 PECOS PAC ID: 8022327832 Enrollment ID: I20151019000605 |
| Provider Name | Ian A Jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598084691 PECOS PAC ID: 0244554277 Enrollment ID: I20151214001575 |
| Provider Name | Henry D Lyon |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1467476184 PECOS PAC ID: 9931403458 Enrollment ID: I20160203002091 |
| Provider Name | Christian A Peabody |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1932106564 PECOS PAC ID: 7416256136 Enrollment ID: I20160502002044 |
| Provider Name | Jonathan Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245686161 PECOS PAC ID: 6709177553 Enrollment ID: I20160624001599 |
| Provider Name | Rebecca J Chicoine |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1376991984 PECOS PAC ID: 4183917446 Enrollment ID: I20160725000172 |
| Provider Name | Prakash T Shrestha |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427045392 PECOS PAC ID: 4486630456 Enrollment ID: I20160801002729 |
| Provider Name | Molly Lininger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043685670 PECOS PAC ID: 1759677040 Enrollment ID: I20160913001776 |
| Provider Name | Lauren Stouffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407119878 PECOS PAC ID: 4183876659 Enrollment ID: I20161018000057 |
| Provider Name | Angela L Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972053825 PECOS PAC ID: 3971881517 Enrollment ID: I20161101002713 |
| Provider Name | Andrea L Ramthun |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1841640521 PECOS PAC ID: 3577843705 Enrollment ID: I20161206000670 |
| Provider Name | Laurel J Yoder |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1336514587 PECOS PAC ID: 3678859444 Enrollment ID: I20170410001112 |
| Provider Name | Adrienne Lapidos |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750618138 PECOS PAC ID: 8628355054 Enrollment ID: I20170511001877 |
| Provider Name | Terrence J Conway |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851310122 PECOS PAC ID: 2567622764 Enrollment ID: I20170602000898 |
| Provider Name | Katherine M Radakovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043330798 PECOS PAC ID: 5698803153 Enrollment ID: I20170627003205 |
| Provider Name | Darren Parker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710381090 PECOS PAC ID: 0042589962 Enrollment ID: I20170710001561 |
| Provider Name | Christina E Oldham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154833879 PECOS PAC ID: 8729345921 Enrollment ID: I20171127000085 |
| Provider Name | Stacy L Lamontagna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003323775 PECOS PAC ID: 8527327436 Enrollment ID: I20180123001987 |
| Provider Name | Stacy Hendershott |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1255875472 PECOS PAC ID: 5698059624 Enrollment ID: I20180126000963 |
| Provider Name | Grace S Siekman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710410956 PECOS PAC ID: 0042572794 Enrollment ID: I20180319000182 |
| Provider Name | Marc Rangel |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1073027579 PECOS PAC ID: 7315202553 Enrollment ID: I20180517002129 |
| Provider Name | Timothy Amborski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629578703 PECOS PAC ID: 3375808983 Enrollment ID: I20180601001293 |
| Provider Name | Patrick J Murphy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134558141 PECOS PAC ID: 2961757026 Enrollment ID: I20180614000890 |
| Provider Name | Jennifer Severe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336581933 PECOS PAC ID: 2163647702 Enrollment ID: I20180717002316 |
| Provider Name | Kamani N Meriwether |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1699261305 PECOS PAC ID: 3971852963 Enrollment ID: I20180824000934 |
| Provider Name | Jenny L Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184102097 PECOS PAC ID: 0941551998 Enrollment ID: I20181001002971 |
| Provider Name | Cindy Lou Newberry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043786700 PECOS PAC ID: 0749524502 Enrollment ID: I20181205000643 |
| Provider Name | Sungmin Cho |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1043739295 PECOS PAC ID: 0547535544 Enrollment ID: I20181220000764 |
| Provider Name | Toni G Verhey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730652736 PECOS PAC ID: 8820338130 Enrollment ID: I20190325001215 |
| Provider Name | Marylou Duron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386106151 PECOS PAC ID: 8921334194 Enrollment ID: I20190725001490 |
| Provider Name | Jacob Carlisle |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1437718301 PECOS PAC ID: 6406183896 Enrollment ID: I20190807003509 |
| Provider Name | Tringo Dessie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326695552 PECOS PAC ID: 9739419474 Enrollment ID: I20190924001238 |
| Provider Name | Brianna C Medlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104472299 PECOS PAC ID: 7810228103 Enrollment ID: I20191017002694 |
| Provider Name | Cynthia-mendon Wister Kelrick |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1407499908 PECOS PAC ID: 9931534492 Enrollment ID: I20200110002593 |
| Provider Name | Alex Lahood |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1043694854 PECOS PAC ID: 6103106406 Enrollment ID: I20200304001338 |
| Provider Name | Lucette Ghislaine Henry Saturne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700025822 PECOS PAC ID: 9234547464 Enrollment ID: I20210428000125 |
| Provider Name | Betsy Fuzi |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1659949998 PECOS PAC ID: 6002210879 Enrollment ID: I20210802003100 |
| Provider Name | Catharine Roos |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1982867883 PECOS PAC ID: 9638320864 Enrollment ID: I20210817001321 |
| Provider Name | Andrew J Kuiper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801472881 PECOS PAC ID: 5092105502 Enrollment ID: I20211123002757 |
| Provider Name | Joseph Kaunda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609494194 PECOS PAC ID: 7416349899 Enrollment ID: I20220114000793 |
| Provider Name | Erin K Beckman |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1538812359 PECOS PAC ID: 0547648602 Enrollment ID: I20220601001329 |
| Provider Name | Lindsay Marie Scheffers |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1215684402 PECOS PAC ID: 3870971492 Enrollment ID: I20220609001129 |
| Provider Name | Catherine Hopkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588320329 PECOS PAC ID: 4284016973 Enrollment ID: I20220727002752 |
| Provider Name | Vonetta R Mcginnis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750539037 PECOS PAC ID: 4789066481 Enrollment ID: I20220727002998 |
| Provider Name | Amanda Bentley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265157812 PECOS PAC ID: 2769850239 Enrollment ID: I20221115002146 |
| Provider Name | Min Chul Kwon |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1437112380 PECOS PAC ID: 1658743125 Enrollment ID: I20230209001047 |
| Provider Name | Kayla Tillman |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1154907525 PECOS PAC ID: 4082070032 Enrollment ID: I20230516003518 |
| Provider Name | Ryan Kiser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619663846 PECOS PAC ID: 0345606398 Enrollment ID: I20230516003547 |
| Provider Name | Alexandra Rose Vroom |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1528742822 PECOS PAC ID: 3173987286 Enrollment ID: I20230907003223 |
| Provider Name | Arturo Trevino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720776487 PECOS PAC ID: 4789035767 Enrollment ID: I20240104001491 |
| Provider Name | Erick Pena |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437826328 PECOS PAC ID: 8022558857 Enrollment ID: I20240909000370 |
| Provider Name | Claudia Pozo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295116648 PECOS PAC ID: 4284175571 Enrollment ID: I20240926002918 |
| Provider Name | Roberto Overton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992119341 PECOS PAC ID: 1254862345 Enrollment ID: I20240930003492 |
| Provider Name | Jay J Kennard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851398523 PECOS PAC ID: 7911904982 Enrollment ID: I20241012000108 |
| Provider Name | Keesha Danielle Mckee |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245884063 PECOS PAC ID: 0042284754 Enrollment ID: I20250326000411 |
| Provider Name | Heather N Rausch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790336675 PECOS PAC ID: 2264950807 Enrollment ID: I20250516002004 |
Bronson Lakeview Hospital Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 520 Railroad St, Bangor, MI 49013 Phone: 269-427-5811 Fax: 269-427-6107 | |
Intercare Community Heath Network Medical Van Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 308 Charles Street, Bangor, MI 49013 Phone: 269-427-7937 Fax: 269-427-5180 | |
Intercare Community Health Network Dental Van Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 308 Charles Street, Bangor, MI 49013 Phone: 269-427-7937 Fax: 269-427-5180 | |
Bronson South Haven Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 520 Railroad St, Bangor, MI 49013 Phone: 269-427-5811 Fax: 269-427-6107 | |
Intercare Community Health Network Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 308 Charles St, Bangor, MI 49013 Phone: 269-427-7967 Fax: 269-427-9539 |