MEDICARE: HACKLEY 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	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700F111940	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1497798029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HACKLEY HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 1847
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49443-1847
Country	:	US
Telephone Number	:	231-727-4444
Fax Number	:	231-727-4451

Provider Business Practice Location Address
First Line	:	6401 PRAIRIE ST
Second Line	:	SUITE 1200
City	:	MUSKEGON
State	:	MI
Zip	:	49444-7840
Country	:	US
Telephone Number	:	231-724-7800
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF NETWORK PHYSICIAN SERVI
Name	:	MICHELLE LOHMAN
Credential	:
Telephone Number	:	231-727-4499

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/16/2014

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Directions to “HACKLEY HOSPITAL ” Practice Location

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