Healthcare Provider Details

I. General information

NPI: 1821081639
Provider Name (Legal Business Name): BRONSON METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 HEALTH PKWY
PAW PAW MI
49079-8242
US

IV. Provider business mailing address

52375 N MAIN ST
MATTAWAN MI
49071-9332
US

V. Phone/Fax

Practice location:
  • Phone: 269-668-6205
  • Fax: 269-668-5071
Mailing address:
  • Phone: 269-668-6205
  • Fax: 269-668-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301006938
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA EAST
Title or Position: CFO
Credential:
Phone: 269-341-8536