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General NPI Number Information
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NPI Number | 1568536621
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Entity Type | Organization
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Legal Business Name | HPCN
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 1715 PECK ST
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City | MUSKEGON
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State | MI
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Zip | 49441-2507
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Country | US
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Telephone | 231-722-7128
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Fax | 231-722-2598
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Provider Business Mailing Address
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Address Line | 1715 PECK ST
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City | MUSKEGON
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State | MI
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Zip | 49441-2507
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Country | US
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Telephone | 231-722-7128
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Fax | 231-722-2598
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Authorized Official
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Title or Position | MGR
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Name | LINDA ELLISON
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Credential |
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Telephone | 231-728-1678
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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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