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General NPI Number Information
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NPI Number | 1184646267
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Entity Type | Organization
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Legal Business Name | RAPPHA MEDICAL CENTER, P.L.L.C.
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 3911 STONEGATE PARK DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085
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Country | US
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Telephone | 269-408-1777
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Fax | 269-408-1755
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Provider Business Mailing Address
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Address Line | 3911 STONEGATE PARK DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085
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Country | US
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Telephone | 269-408-1777
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Fax | 269-408-1755
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. SHERRELL A O'DONNELL
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Credential | D.O.
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Telephone | 269-408-1777
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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 | 5101014079
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License Number State | MI
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