Basic Information
| Provider Information | |||||||||
| NPI: | 1598099699 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STURGIS HOSPITAL, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STURGIS HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 916 MYRTLE ST | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490912326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696517824 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 916 MYRTLE ST | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490912326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696517824 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2009 | ||||||||
| LastUpdateDate: | 12/20/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LABARGE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2696517824 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 230096 | 01 | MI | PTAN | OTHER |