Healthcare Provider Details

I. General information

NPI: 1982974515
Provider Name (Legal Business Name): MGH FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S GETTY ST
MUSKEGON MI
49444-1207
US

IV. Provider business mailing address

2201 S GETTY ST
MUSKEGON MI
49444-1207
US

V. Phone/Fax

Practice location:
  • Phone: 231-739-9315
  • Fax: 231-733-7380
Mailing address:
  • Phone: 231-739-9315
  • Fax: 231-733-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE WALLACE
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 231-739-9315