Healthcare Provider Details

I. General information

NPI: 1063535805
Provider Name (Legal Business Name): HESPERIA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 N DIVISION
HESPERIA MI
49421
US

IV. Provider business mailing address

78 N DIVISION PO BOX 308
HESPERIA MI
49421
US

V. Phone/Fax

Practice location:
  • Phone: 231-854-6415
  • Fax: 231-854-6975
Mailing address:
  • Phone: 231-854-6415
  • Fax: 231-854-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number009157
License Number StateMI

VIII. Authorized Official

Name: MS. DIANNA L BROWN
Title or Position: PRACTICE MANAGER
Credential: FNP
Phone: 231-854-6415