Healthcare Provider Details

I. General information

NPI: 1447474267
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: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52375 N MAIN ST
MATTAWAN MI
49071-9332
US

IV. Provider business mailing address

301 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-668-3348
  • Fax: 269-668-7702
Mailing address:
  • Phone: 269-341-7806
  • Fax: 269-341-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number80-0041
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA EAST
Title or Position: SVP, CFO
Credential:
Phone: 269-341-6000