Healthcare Provider Details

I. General information

NPI: 1699709360
Provider Name (Legal Business Name): HASTINGS EMERGENCY PHYSICIANS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W GREEN ST
HASTINGS MI
49058-1710
US

IV. Provider business mailing address

PO BOX 2332
GRAND RAPIDS MI
49501-2332
US

V. Phone/Fax

Practice location:
  • Phone: 269-945-3451
  • Fax:
Mailing address:
  • Phone: 616-975-1845
  • Fax: 616-975-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY POHOLSKI
Title or Position: DIRECTOR
Credential:
Phone: 616-975-1845