Healthcare Provider Details

I. General information

NPI: 1538383351
Provider Name (Legal Business Name): BRONSON LAKEVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MAIN ST
MARCELLUS MI
49067-8523
US

IV. Provider business mailing address

110 E MAIN ST
MARCELLUS MI
49067-8523
US

V. Phone/Fax

Practice location:
  • Phone: 269-646-5004
  • Fax: 269-646-6002
Mailing address:
  • Phone: 269-646-5004
  • Fax: 269-646-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number80-0041
License Number StateMI

VIII. Authorized Official

Name: MARY M MEITZ
Title or Position: VP OF FINANCE
Credential:
Phone: 269-341-7654