Healthcare Provider Details

I. General information

NPI: 1972589489
Provider Name (Legal Business Name): MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N ATKINSON DR
LUDINGTON MI
49431-1906
US

IV. Provider business mailing address

1 N ATKINSON DR
LUDINGTON MI
49431-1906
US

V. Phone/Fax

Practice location:
  • Phone: 231-843-2591
  • Fax: 231-845-3696
Mailing address:
  • Phone: 231-843-2591
  • Fax: 231-845-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number530010
License Number StateMI

VIII. Authorized Official

Name: MR. DREW DOSTAL
Title or Position: REGIONAL MARKET LEADER
Credential:
Phone: 231-924-1340