NPIMap

Organization Active NPI

Van Buren Community Mental Health Physician Professional Group

  • Psychosomatic Medicine Physician
  • Paw Paw, MI
National Provider Identifier
1164744595
Registry record updated Feb 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychosomatic Medicine PhysicianTaxonomy code 2084P0015X
Legal business name
VAN BUREN COMMUNITY MENTAL HEALTH PHYSICIAN PROFESSIONAL GROUP
Practice address
801 Hazen Street
Suite C
Paw Paw, MI 49079-0249
Phone
(269) 657-5574
Fax
(269) 657-3474
NPI assigned
Feb 26, 2010
Last updated
Feb 26, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2010

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

Authorized official

Name
Mrs. Debra L.-R. Hess
Title
Chief Executive Officer
Phone
(269) 657-5574

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychosomatic Medicine Physician 2084P0015X Primary

Addresses

Primary practice location

801 Hazen Street
Suite C
Paw Paw, MI 49079-0249

Mailing address

P.O. Box 249
801 Hazen Street Suite C
Paw Paw, MI 49079-0249
Phone (269) 657-5574

National Provider Directory

National Provider Directory
Tax ID family
Van Buren Health Authority6 organizations share this tax ID, including this one
Part of
Van Buren Health Authority

Other organizations with this tax ID 5

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": "1267142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267142400000",
    "number": "1164744595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 249",
            "address_2": "801 HAZEN STREET SUITE C",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790249",
            "telephone_number": "269-657-5574",
            "fax_number": "269-657-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 HAZEN STREET",
            "address_2": "SUITE C",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790249",
            "telephone_number": "269-657-5574",
            "fax_number": "269-657-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN BUREN COMMUNITY MENTAL HEALTH PHYSICIAN PROFESSIONAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY",
        "enumeration_date": "2010-02-26",
        "last_updated": "2010-02-26",
        "status": "A",
        "authorized_official_last_name": "HESS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "L.-R.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "269-657-5574",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paw Paw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2010; 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.