Healthcare Provider Details

I. General information

NPI: 1548266778
Provider Name (Legal Business Name): NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S SULLIVAN ST
FREMONT MI
49412
US

IV. Provider business mailing address

212 S SULLIVAN ST
FREMONT MI
49412
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-1300
  • Fax: 231-924-1320
Mailing address:
  • Phone: 231-924-1300
  • Fax: 231-924-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number620010
License Number StateMI

VIII. Authorized Official

Name: MR. RANDALL J STASIK
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 231-924-1340