NPIMap

Organization Active NPI

Lee Memorial Hospital

  • Nurse Practitioner
  • Dowagiac, MI
National Provider Identifier
1346415973
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
LEE MEMORIAL HOSPITAL
Practice address
520 Main St
Dowagiac, MI 49047-1762
Phone
(269) 783-3052
NPI assigned
Apr 24, 2008
Last updated
Apr 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Authorized official

Name
Kenneth Holst
Title
Cfo
Phone
(269) 783-3034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

520 Main St
Dowagiac, MI 49047-1762

Mailing address

420 W High St
Dowagiac, MI 49047-1943

Other identifiers 1

IdentifierTypeStateIssuer
0A41004OtherBCBSM PIN

National Provider Directory

National Provider Directory
Tax ID family
Lee Mem Hosp Family Pra9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

520 Main St
Dowagiac, MI 49047
Phone (269) 390-0536

NPI Registry JSON

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1346415973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W HIGH ST",
            "city": "DOWAGIAC",
            "state": "MI",
            "postal_code": "490471943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MAIN ST",
            "city": "DOWAGIAC",
            "state": "MI",
            "postal_code": "490471762",
            "telephone_number": "269-783-3052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "HOLST",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "269-783-3034"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PIN",
            "identifier": "0A41004",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dowagiac, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; 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.