Healthcare Provider Details

I. General information

NPI: 1184807174
Provider Name (Legal Business Name): MECOSTA HEALTH SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 06/21/2011
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 Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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