NPIMap

Organization Active NPI

Pennock Hospital Board of Trustees

  • Family Medicine Physician
  • Ionia, MI
National Provider Identifier
1104291202
Registry record updated Jan 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PENNOCK HOSPITAL BOARD OF TRUSTEES
Practice address
2776 S State Rd
Ionia, MI 48846-8472
Phone
(616) 486-6790
NPI assigned
Dec 1, 2015
Last updated
Jan 25, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PENNOCK HOSPITAL BOARD OF TRUSTEESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2016

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

Authorized official

Name
Connie Downs
Title
VP Finance
Phone
(269) 948-3122

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X

Addresses

Primary practice location

2776 S State Rd
Ionia, MI 48846-8472

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560
Phone (616) 486-6790

National Provider Directory

National Provider Directory
Tax ID family
Kenneth Steward DO13 organizations share this tax ID, including this one
Part of
Kenneth Steward DO

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1448928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453680000000",
    "number": "1104291202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-486-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2776 S STATE RD",
            "city": "IONIA",
            "state": "MI",
            "postal_code": "488468472",
            "telephone_number": "616-486-6790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNOCK HOSPITAL BOARD OF TRUSTEES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENNOCK HOSPITAL BOARD OF TRUSTEES",
        "enumeration_date": "2015-12-01",
        "last_updated": "2016-01-25",
        "status": "A",
        "authorized_official_last_name": "DOWNS",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "269-948-3122"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ionia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; 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.