MEDICARE: BORGESS LEE MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1023158235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORGESS LEE MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	420 W HIGH ST
Second Line	:
City	:	DOWAGIAC
State	:	MI
Zip	:	49047-1943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 S BROADWAY ST
Second Line	:
City	:	CASSOPOLIS
State	:	MI
Zip	:	49031-1242
Country	:	US
Telephone Number	:	269-445-0771
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	WILLIAM DAAM
Credential	:
Telephone Number	:	269-783-3080

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/07/2008

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