| Ravenna Family Practice, P.c. | |
|
12520 Crockery Creek Dr. Ravenna MI 49451 | |
| (231) 853-2954 | |
| (231) 853-6089 |
| Full Name | Ravenna Family Practice, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 12520 Crockery Creek Dr., Ravenna, Michigan |
| Authorized Official Name and Position | Timothy Lee Beechnau (OWNER) |
| Authorized Official Contact | 2318532954 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ravenna Family Practice, P.c. 12520 Crockery Creek Dr. Ravenna MI 49451 Ph: (231) 853-2954 | Ravenna Family Practice, P.c. 12520 Crockery Creek Dr. Ravenna MI 49451 Ph: (231) 853-2954 |
| NPI Number | 1497928469 |
|---|---|
| Provider Enumeration Date | 04/10/2008 |
| Last Update Date | 04/10/2008 |
| Medicare PECOS PAC ID | 8224023148 |
|---|---|
| Medicare Enrollment ID | O20040423001167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497928469 | NPI | - | NPPES |
| 4480790 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 008430 (Michigan) | Primary |
| Provider Name | Timothy L Beechnau |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1083619936 PECOS PAC ID: 9133114069 Enrollment ID: I20040421000797 |
| Provider Name | Kelley Marie Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346413309 PECOS PAC ID: 9638166341 Enrollment ID: I20040426001708 |
| Provider Name | Nicholas S Beechnau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164784724 PECOS PAC ID: 1658507637 Enrollment ID: I20131121000921 |
Hackley Community Care Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2700 S Ravenna Rd Rm A101, Ravenna, MI 49451 Phone: 231-737-1335 | |
Apple Family Medicine, P.l.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1042 S Ravenna Rd, Ravenna, MI 49451 Phone: 517-420-6817 |