Healthcare Provider Details

I. General information

NPI: 1619039682
Provider Name (Legal Business Name): BORGESS LEE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S BROADWAY STREET
CASSOPOLIS MI
49031-1242
US

IV. Provider business mailing address

420 WEST HIGH STREET
DOWAGIAC MI
49047-1943
US

V. Phone/Fax

Practice location:
  • Phone: 269-445-0771
  • Fax: 269-445-0939
Mailing address:
  • Phone: 269-783-3089
  • Fax: 269-783-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberSFE1414003186
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: JOHN RYDER
Title or Position: COO
Credential:
Phone: 269-783-3080