Basic Information
| Provider Information | |||||||||
| NPI: | 1497807978 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PORTAGE HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | HANCOCK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499301569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064831000 | ||||||||
| FaxNumber: | 9064831122 | ||||||||
| Practice Location | |||||||||
| Address1: | 945 NINTH ST. | ||||||||
| Address2: | |||||||||
| City: | LAKE LINDEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499151100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064831030 | ||||||||
| FaxNumber: | 9062960521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOGAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9064831000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.