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1720475023 NPI number — PENNOCK HOSPITAL

NPI Number: 1720475023
Health Care Provider/Practitioner: PENNOCK HOSPITAL

Information about “1720475023” NPI (PENNOCK HOSPITAL) exists in 1720475023 in HTML format HTML  |  1720475023 in plain Text format TXT  |  1720475023 in PDF (Portable Document Format) PDF  |  1720475023 in an XML format XML  formats.

NPI Number : 1720475023 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720475023",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "PENNOCK HOSPITAL",
    "ParentOrgTIN": null,
    "OrgName": "PENNOCK HOSPITAL",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "100 MICHIGAN ST NE",
    "SecondLineMailingAddress": "MC 845",
    "MailingAddressCityName": "GRAND RAPIDS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49503-2560",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "616-486-6790",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "551 LINN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALLEGAN",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49010-1595",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "269-945-9520",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/24/2015",
    "LastUpdateDate": "10/01/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KING",
    "AuthorizedOfficialFirstName": "MICHAEL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CONTROLLER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "269-948-3122",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207X00000X",
          "TaxonomyName": "Orthopaedic Surgery Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2081P2900X",
          "TaxonomyName": "Pain Medicine (Physical Medicine & Rehabilitation) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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