Healthcare Provider Details

I. General information

NPI: 1497807978
Provider Name (Legal Business Name): PORTAGE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 NINTH ST.
LAKE LINDEN MI
49915-1100
US

IV. Provider business mailing address

500 CAMPUS DR
HANCOCK MI
49930-1569
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1030
  • Fax: 906-296-0521
Mailing address:
  • Phone: 906-483-1000
  • Fax: 906-483-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES BOGAN
Title or Position: PRESIDENT
Credential:
Phone: 906-483-1000