Provider Demographics
NPI:1770696080
Name:RED CEDAR FAMILY CARE, PLLC
Entity type:Organization
Organization Name:RED CEDAR FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:G
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-655-7300
Mailing Address - Street 1:1288 W GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9374
Mailing Address - Country:US
Mailing Address - Phone:517-655-7300
Mailing Address - Fax:517-655-7333
Practice Address - Street 1:1288 W GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-9374
Practice Address - Country:US
Practice Address - Phone:517-655-7300
Practice Address - Fax:517-655-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0100197OtherPHP FOR NELSON
MI5330084OtherBCN FOR NELSON
MI4756773Medicaid
MI5330007OtherBCN FOR BOLLMAN
MI0100352OtherPHP FOR BOLLMAN
MI4756782Medicaid
MI0100197OtherPHP FOR NELSON
MI5330007OtherBCN FOR BOLLMAN
MI5330084OtherBCN FOR NELSON
MIF13221Medicare UPIN