Healthcare Provider Details

I. General information

NPI: 1174749170
Provider Name (Legal Business Name): BRONSON SOUTH HAVEN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/27/2023
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S BAILEY AVE
SOUTH HAVEN MI
49090-8744
US

IV. Provider business mailing address

601 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-637-5271
  • Fax: 269-639-2818
Mailing address:
  • Phone: 269-341-8419
  • Fax: 269-341-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number800020
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1060000042
License Number StateMI

VIII. Authorized Official

Name: MS. REBECCA L EAST
Title or Position: SVP, CFO
Credential:
Phone: 269-341-6000