Basic Information
| Provider Information | |||||||||
| NPI: | 1023158235 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BORGESS LEE MEMORIAL HOSPITAL | ||||||||
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| OtherOrganizationName: | BORGESS LEE MEMORIAL MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | DOWAGIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490471943 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 117 S BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | CASSOPOLIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490311242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694450771 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | DAAM | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 2697833080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.