Basic Information
| Provider Information | |||||||||
| NPI: | 1447474267 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRONSON LAKEVIEW HOSPITAL | ||||||||
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| OtherOrganizationName: | BRONSON LAKEVIEW FAMILY CARE-MATTAWAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 JOHN ST | ||||||||
| Address2: | BOX 42 | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693417806 | ||||||||
| FaxNumber: | 2693418913 | ||||||||
| Practice Location | |||||||||
| Address1: | 52375 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MATTAWAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490719332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696683348 | ||||||||
| FaxNumber: | 2696687702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 08/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | EAST | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP, CFO | ||||||||
| AuthorizedOfficialTelephone: | 2693416000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BRONSON LAKEVIEW HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 282NR1301X | 80-0041 | MI | N | Hospitals | General Acute Care Hospital | Rural | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.