MEDICARE: PLANNED PARENTHOOD OF WEST & NORTHERN MICHIGAN, 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	261QF0050X	Non-Surgical Family Planning Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699886218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANNED PARENTHOOD OF WEST & NORTHERN MICHIGAN, INC.

Provider Business Mailing Address
First Line	:	425 CHERRY ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503
Country	:	US
Telephone Number	:	606-774-7005
Fax Number	:	616-774-0516

Provider Business Practice Location Address
First Line	:	1003 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-2810
Country	:	US
Telephone Number	:	231-347-9692
Fax Number	:	231-348-1908

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	DEB LANTINGA
Credential	:
Telephone Number	:	616-774-7005

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/12/2007

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Directions to “PLANNED PARENTHOOD OF WEST & NORTHERN MICHIGAN, INC. ” Practice Location

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