Pennock Hospital Board of Trustees
Organization Active NPI Family Medicine Physician · Ionia, MI
NPI 1104291202 · NPPES record last updated Jan 25, 2016
Key facts
- NPI
- 1104291202
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 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
- Organization subpart
- Yes
- Parent organization (as reported)
- PENNOCK HOSPITAL BOARD OF TRUSTEES
Authorized official
- Name
- Connie Downs
- Title
- VP Finance
- Phone
- (269) 948-3122
Corporate family (same tax ID) 12
National Provider Directory
- Tax ID family
- Deborah a Joseph DO
- Part of
- Deborah a Joseph DO
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| 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
Other providers in Ionia, MI
- PDS I Michigan Inc
- Robert J Peacock
- Ashley Peer
- Dana Pendergrass
- Pennock Hospital
- Perla P Garza Therapy LLC
- Melissa Perla
- Matthew Perron
- Joshua Peterman
- Raeyanna Jazlyhn Peters
All providers in Ionia, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.