Basic Information
| Provider Information | |||||||||
| NPI: | 1750403325 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION | ||||||||
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| OtherOrganizationName: | SPECTRUM HEALTH GERBER MEMORIAL PEDIATRICS AND WALK IN CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494121181 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 204 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494121181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319241800 | ||||||||
| FaxNumber: | 2319241810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | NICHOLS | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 2319241347 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 081343 | MI | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207V00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.