Healthcare Provider Details

I. General information

NPI: 1003990201
Provider Name (Legal Business Name): HPCN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1877 N GETTY ST
N MUSKEGON MI
49445-8563
US

IV. Provider business mailing address

1877 N GETTY ST
N MUSKEGON MI
49445-8563
US

V. Phone/Fax

Practice location:
  • Phone: 231-728-5073
  • Fax: 231-728-5086
Mailing address:
  • Phone: 231-728-5073
  • Fax: 231-728-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301060189
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301072876
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301077504
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301063121
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301077595
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301080510
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002357
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43010085193
License Number StateMI
# 9
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301039064
License Number StateMI

VIII. Authorized Official

Name: LINDA ELLISON
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 231-728-1678