Healthcare Provider Details

I. General information

NPI: 1891898847
Provider Name (Legal Business Name): MGH FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
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: 231-737-1706
  • Fax: 231-737-1814
Mailing address:
  • Phone: 231-737-1706
  • Fax: 231-737-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL OGLESBY
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential:
Phone: 231-739-9315