MEDICARE: OA HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1548874860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OA HEALTH INC

Provider Business Mailing Address
First Line	:	4172 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4527
Country	:	US
Telephone Number	:	616-419-4996
Fax Number	:	616-419-4997

Provider Business Practice Location Address
First Line	:	4172 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4527
Country	:	US
Telephone Number	:	616-419-4996
Fax Number	:	616-419-4997

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL HUNGERFORD
Credential	:
Telephone Number	:	616-419-4996

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	09/03/2020

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