MEDICARE: MUSKEGON PREGNANCY SERVICES

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	251S00000X	Community/Behavioral Health Agency	2083PO901X	MI

General Provider Information

NPI Number	:	1184161960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSKEGON PREGNANCY SERVICES

Provider Business Mailing Address
First Line	:	1775 WELLS AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-2459
Country	:	US
Telephone Number	:	231-726-2677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 WELLS AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-2459
Country	:	US
Telephone Number	:	231-726-2677
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. DEBRA NULL
Credential	:
Telephone Number	:	231-726-2677

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	01/31/2017

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