Healthcare Provider Details

I. General information

NPI: 1528007952
Provider Name (Legal Business Name): MECOSTA HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LINDEN ST SUITE 1
BIG RAPIDS MI
49307-1879
US

IV. Provider business mailing address

650 LINDEN ST SUITE 1
BIG RAPIDS MI
49307-1879
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-3200
  • Fax: 231-796-5562
Mailing address:
  • Phone: 231-796-3200
  • Fax: 231-796-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004630
License Number StateMI

VIII. Authorized Official

Name: MRS. LAURIE SCHAFER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 231-592-4217