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General NPI Number Information
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NPI Number | 1013247972
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Entity Type | Organization
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Legal Business Name | PORTAGE HEALTH INC
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Dates
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Enumeration Date | 12/28/2009
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 921 W SHARON AVE.
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City | HOUGHTON
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State | MI
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Zip | 49931
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Country | US
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Telephone | 906-483-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 921 W SHARON AVE.
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City | HOUGHTON
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State | MI
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Zip | 49931
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Country | US
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Telephone | 906-483-1000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES BOGAN
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Credential |
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Telephone | 906-483-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 310020
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License Number State | MI
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