Healthcare Provider Details

I. General information

NPI: 1619059458
Provider Name (Legal Business Name): HARBOR BEACH COMMUNITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 1ST ST
HARBOR BEACH MI
48441-1236
US

IV. Provider business mailing address

210 S 1ST ST
HARBOR BEACH MI
48441-1236
US

V. Phone/Fax

Practice location:
  • Phone: 989-479-3201
  • Fax: 989-479-5000
Mailing address:
  • Phone: 989-479-3201
  • Fax: 989-479-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301067040
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number4301076866
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101013107
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004034
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301078947
License Number StateMI

VIII. Authorized Official

Name: JILL WEHNER
Title or Position: VP/COO
Credential:
Phone: 989-479-3201