NPIMap

Organization Active NPI

Pennock Hospital Board of Trustees

  • Women's Health Nurse Practitioner
  • Delton, MI
National Provider Identifier
1780046227
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
Legal business name
PENNOCK HOSPITAL BOARD OF TRUSTEES
Practice address
11275 Sprague Rd
Delton, MI 49046-8493
Phone
(269) 623-5150
NPI assigned
Mar 23, 2016
Last updated
Mar 23, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PENNOCK HOSPITAL BOARD OF TRUSTEESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Robert Davis
Title
Director of Operations
Phone
(269) 945-1220

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU
Women's Health Nurse Practitioner 363LW0102X NU Primary

Addresses

Primary practice location

11275 Sprague Rd
Delton, MI 49046-8493

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

National Provider Directory

National Provider Directory
Tax ID family
Pennock Hospital Borad13 organizations share this tax ID, including this one
Part of
Pennock Hospital Borad

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1780046227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11275 SPRAGUE RD",
            "city": "DELTON",
            "state": "MI",
            "postal_code": "490468493",
            "telephone_number": "269-623-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNOCK HOSPITAL BOARD OF TRUSTEES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENNOCK HOSPITAL BOARD OF TRUSTEES",
        "enumeration_date": "2016-03-23",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "269-945-1220"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; 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.