Basic Information
| Provider Information | |||||||||
| NPI: | 1144275934 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASCENSION BORGESS HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BORGESS FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 SHAFFER ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490481623 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 345 NAOMI ST | ||||||||
| Address2: | |||||||||
| City: | PLAINWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490801257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695520100 | ||||||||
| FaxNumber: | 2695520111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | BERGMANN | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | U | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 2692264800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.