Healthcare Provider Details

I. General information

NPI: 1750403325
Provider Name (Legal Business Name): NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W MAIN ST
FREMONT MI
49412-1181
US

IV. Provider business mailing address

204 W MAIN ST
FREMONT MI
49412-1181
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-1800
  • Fax: 231-924-1810
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number081343
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN SELLA
Title or Position: VP
Credential:
Phone: 616-802-0206