MEDICARE: NORTH OTTAWA COMMUNITY HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BX2000X	Oxygen Equipment & Supplies (DME)
2	333600000X	Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1114227329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH OTTAWA COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	1445 SHELDON AVE
Second Line	:	SUITE 104
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2402
Country	:	US
Telephone Number	:	616-847-5504
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 SHELDON AVE
Second Line	:	SUITE 104
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2402
Country	:	US
Telephone Number	:	616-847-5504
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE
Name	:	DONALD J LONGPRE
Credential	:	CFO
Telephone Number	:	616-842-3600

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	10/22/2010

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