Healthcare Provider Details

I. General information

NPI: 1093749848
Provider Name (Legal Business Name): ASCENSION BORGESS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 GULL RD
KALAMAZOO MI
49048-1640
US

IV. Provider business mailing address

1717 SHAFFER STREET SUITE 002
KALAMAZOO MI
49048
US

V. Phone/Fax

Practice location:
  • Phone: 269-226-5166
  • Fax:
Mailing address:
  • Phone: 269-552-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MARINA HOUGHTON
Title or Position: CFO
Credential:
Phone: 269-226-4800