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General NPI Number Information
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NPI Number | 1598909426
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Entity Type | Organization
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Legal Business Name | SPECTRUM HEATLH KELSEY
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 418 WASHINGTON ST
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City | LAKEVIEW
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State | MI
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Zip | 48850-9806
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Country | US
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Telephone | 989-352-7211
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Fax | 616-754-2735
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Provider Business Mailing Address
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Address Line | 418 WASHINGTON ST
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City | LAKEVIEW
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State | MI
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Zip | 48850-9806
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Country | US
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Telephone | 989-352-7211
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Fax | 616-754-2735
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Authorized Official
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Title or Position | VP, FINANCE
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Name | MR. RYAN K JOHNSON
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Credential |
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Telephone | 616-225-6310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 490051
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License Number State | MI
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