Lakeshore Community Hospital, Inc.
Organization Active NPI Family Medicine Physician · Hart, MI
NPI 1174889604 · NPPES record last updated Apr 24, 2013
Key facts
- NPI
- 1174889604
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- RO009698 (MI)
- Legal business name
- LAKESHORE COMMUNITY HOSPITAL, INC.
- Practice address
- 611 E Main St
Hart, MI 49420-1190 - Phone
- (231) 873-5675
- Fax
- (231) 873-1825
- NPI assigned
- Apr 10, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- MERCY HEATLH PARTNERS LAKESHORE CAMPUS
Authorized official
- Name
- Yara Villanueva
- Title
- Clinic Reimbursement Coordinator
- Phone
- (231) 873-5675
Corporate family (same tax ID) 5
National Provider Directory
- Tax ID family
- Lakeshore Community Hos
- Part of
- Lakeshore Community Hos
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | AB033570 | MI | |
| Family Medicine Physician |
207Q00000X | RO009698 | MI | Yes |
| Family Medicine Physician |
207Q00000X | PW011554 | MI | |
| Physician Assistant |
363A00000X | CU005544 | MI | |
| Physician Assistant |
363A00000X | JT003148 | MI |
Addresses
Primary practice location
611 E Main St
Hart, MI 49420-1190
Mailing address
611 E Main St
Hart, MI 49420-1190
Phone (231) 873-5675
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3015197 | Medicaid | MI | |
| 0F40011 | Other | BCBS | |
| 2963232 | Medicaid | MI |
Other names
- Hart Family Medical Center
Other providers in Hart, MI
- Elizabeth Johnson
- Lori Lynn Johnson
- Michael Edward Jonassen
- Mike Kozminski
- Brandi Kraley
- Lakeside Comprehensive Rehabilitation Inc.
- Rachelle Ledger
- Brianna Lombard
- Michelle Lee Lyman
- Alexis Marsh
All providers in Hart, 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 Apr 24, 2013. 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.