Portage Hospital LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Hancock, MI
NPI 1366879199 · NPPES record last updated Jan 15, 2026
Key facts
- NPI
- 1366879199
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- PORTAGE HOSPITAL LLC
- Practice address
- 500 Campus Dr
Hancock, MI 49930-1569 - Phone
- (906) 483-1000
- NPI assigned
- Oct 11, 2013
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7688
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 7
Practitioners 3
-
Jeffrey Allen Conklin, M.D.
-
George Alan Krzymowski, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140120000451 | MI | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 1951538883 | Practice locations: Hancock, MI |
National Provider Directory
- Tax ID family
- Portage Hospital LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
500 Campus Dr
Hancock, MI 49930-1569
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-4536
Phone (615) 920-7000
Other names
- Portage Health Dialysis Center
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | phs@direct.uphsportage.net |
Other providers in Hancock, MI
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Physician Practices Inc
- Portage Physician Practices Inc
All providers in Hancock, MI · End-Stage Renal Disease (ESRD) Treatment Clinic/Center 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 15, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.