Basic Information
| Provider Information | |||||||||
| NPI: | 1164818977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DECKERVILLE COMMUNITY HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3532 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DECKERVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484279615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103763100 | ||||||||
| FaxNumber: | 8103768311 | ||||||||
| Practice Location | |||||||||
| Address1: | 3532 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DECKERVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484279615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103763100 | ||||||||
| FaxNumber: | 8103768311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2015 | ||||||||
| LastUpdateDate: | 10/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | GENTNER | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8103762835 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DECKERVILLE COMMUNITY HOSPITAL, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.