Healthcare Provider Details

I. General information

NPI: 1396878773
Provider Name (Legal Business Name): NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 N DIVISION ST
HESPERIA MI
49421-5100
US

IV. Provider business mailing address

78 N DIVISION ST
HESPERIA MI
49421-5100
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 Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

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