Holland Family Medicine PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301028907 Issued in MI

Legal business name

HOLLAND FAMILY MEDICINE PC

Practice address

601 Michigan Ave Ste 104
Holland, MI 49423-4951

Phone

(616) 392-2361

Fax

(616) 392-2364

NPI assigned

Jul 11, 2006

Last updated

Mar 5, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jack Derks, MDNPI 1134144413

Title

Family Practice

Phone

(616) 392-2361

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack O Derks, MD

  • Family Medicine Physician
  • Holland, MI
  • NPI 1134144413
  Authorized official Same address or phone
• Elizabeth Joy Mulder, ANP

  • Adult Health Nurse Practitioner
  • Holland, MI
  • NPI 1124043492
  NPD

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425513600000",
    "number": "1629002852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MICHIGAN AVE STE 104",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234951",
            "telephone_number": "616-392-2361",
            "fax_number": "616-392-2364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 MICHIGAN AVE STE 104",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234951",
            "telephone_number": "616-392-2361",
            "fax_number": "616-392-2364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLAND FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2015-03-05",
        "status": "A",
        "authorized_official_last_name": "DERKS",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "FAMILY PRACTICE",
        "authorized_official_telephone_number": "616-392-2361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301028907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holland Eye Clinic, PC
• Holland Eye Clinic, PC (Holland Eye Surgery & Laser Center)
• Holland Eye Clinic, PC (Holland Eye Surgery And Laser Center)
• Holland Family Counseling LLC
• Holland Family Dentistry
• Holland Foot and Ankle Center PC
• Holland Foot and Ankle Center PC
• Holland Foot and Ankle Center, PC
• Holland Free Health Clinic
• Holland Free Health Clinic

• Family Medicine Physician in Holland, MI
• Providers in Holland, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; 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.