Active NPI
Portage Health Inc
Doing business as Portage Health Dialysis Center
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Hancock, MI
National Provider Identifier
1184786188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- PORTAGE HEALTH INC
- Doing business as
- Portage Health Dialysis Center
- Practice address
- 500 Campus Dr
Hancock, MI 49930-1569 - Phone
- (906) 483-1720
- Fax
- (906) 483-1735
- NPI assigned
- Dec 15, 2006
- Last updated
- Aug 1, 2013
- Organization subpart
- Yes
- Parent organization
- PORTAGE HEALTH INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. James Bogan
- Title
- Ceo
- Phone
- (906) 483-1501
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | NU | Primary |
Addresses
Primary practice location
500 Campus Dr
Hancock, MI 49930-1569
Mailing address
500 Campus Dr
Hancock, MI 49930-1569
Phone (906) 483-1720
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5171691 | Medicaid | MI |
Other names 1
- PORTAGE HEALTH DIALYSIS CENTER
National Provider Directory
National Provider Directory- Part of
- Timothy Andress
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1375315200000",
"number": "1184786188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 CAMPUS DR",
"city": "HANCOCK",
"state": "MI",
"postal_code": "499301569",
"telephone_number": "906-483-1720",
"fax_number": "906-483-1735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 CAMPUS DR",
"city": "HANCOCK",
"state": "MI",
"postal_code": "499301569",
"telephone_number": "906-483-1720",
"fax_number": "906-483-1735"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PORTAGE HEALTH INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PORTAGE HEALTH INC",
"enumeration_date": "2006-12-15",
"last_updated": "2013-08-01",
"status": "A",
"authorized_official_last_name": "BOGAN",
"authorized_official_first_name": "JAMES",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "906-483-1501",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5171691",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PORTAGE HEALTH DIALYSIS CENTER",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Hancock, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.