Healthcare Provider Details

I. General information

NPI: 1598305641
Provider Name (Legal Business Name): LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

IV. Provider business mailing address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-6630
  • Fax:
Mailing address:
  • Phone: 616-486-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: TIM J CALHOUN
Title or Position: VP FINANCE
Credential:
Phone: 269-983-8304