Healthcare Provider Details

I. General information

NPI: 1629214739
Provider Name (Legal Business Name): LAKESHORE COMMUNITY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E COLBY ST
WHITEHALL MI
49461-1262
US

IV. Provider business mailing address

905 E COLBY ST
WHITEHALL MI
49461-1262
US

V. Phone/Fax

Practice location:
  • Phone: 231-728-5910
  • Fax: 231-728-5918
Mailing address:
  • Phone: 231-728-5910
  • Fax: 231-728-5918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. COLLEEN BETH JOHNSON
Title or Position: PRACTICE ADMINISTRATOR
Credential: CMPE, FABC
Phone: 231-728-5910