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General NPI Number Information
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NPI Number | 1104291202
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Entity Type | Organization
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Legal Business Name | PENNOCK HOSPITAL BOARD OF TRUSTEES
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 2776 S STATE RD
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City | IONIA
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State | MI
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Zip | 48846-8472
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Country | US
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Telephone | 616-486-6790
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE MC 845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone | 616-486-6790
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Fax |
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Authorized Official
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Title or Position | VP FINANCE
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Name | CONNIE DOWNS
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Credential |
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Telephone | 269-948-3122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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