NPIMap

Organization Active NPI

Pennock Hospital Board of Trustees

Doing business as Pennock Hospital Lake Odessa Sat Lab

  • General Acute Care Hospital
  • Lake Odessa, MI
National Provider Identifier
1053635359
Registry record updated Mar 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PENNOCK HOSPITAL BOARD OF TRUSTEES
Doing business as
Pennock Hospital Lake Odessa Sat Lab
Practice address
4294 Laurel Dr
Lake Odessa, MI 48849-8430
Phone
(269) 945-1212
Fax
(616) 674-1698
NPI assigned
Mar 16, 2010
Last updated
Mar 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Thomas Salisbury
Title
Finance Director
Phone
(269) 945-1212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X MI Primary

Addresses

Primary practice location

4294 Laurel Dr
Lake Odessa, MI 48849-8430

Mailing address

1009 W Green St
Hastings, MI 49058-1710
Phone (269) 945-1212

Other names 1

  • Pennock Hospital Lake Odessa Sat Lab Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pennock Hospital Borad13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4294 Laurel Dr
Lake Odessa, MI 48849
Phone (616) 374-0099

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362960000000",
    "number": "1053635359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 W GREEN ST",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581710",
            "telephone_number": "269-945-1212",
            "fax_number": "269-948-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4294 LAUREL DR",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488498430",
            "telephone_number": "269-945-1212",
            "fax_number": "616-674-1698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNOCK HOSPITAL BOARD OF TRUSTEES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-16",
        "last_updated": "2013-03-11",
        "status": "A",
        "authorized_official_last_name": "SALISBURY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "269-945-1212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pennock Hospital Lake Odessa Sat Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Odessa, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.