Basic Information
| Provider Information | |||||||||
| NPI: | 1669935615 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MECOSTA COUNTY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MICHIGAN ST NE # MC845 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164866790 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5991 95TH AVE | ||||||||
| Address2: | |||||||||
| City: | EVART | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496319386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318328700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2019 | ||||||||
| LastUpdateDate: | 04/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | KNOERL | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 2318327177 | ||||||||
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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.