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General NPI Number Information
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NPI Number | 1861648404
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Entity Type | Organization
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Legal Business Name | MUSKEGON SC, LLC
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 1400 MERCY DR
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City | MUSKEGON
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State | MI
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Zip | 49444-1836
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Country | US
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Telephone | 720-320-6577
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1878
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF BOARD
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Name | DR. JEFFREY D RECKNAGEL
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Credential | MD
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Telephone | 231-733-1326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | MI
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