Basic Information
| Provider Information | |||||||||
| NPI: | 1982737391 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARSON CITY HOSPITAL | ||||||||
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| OtherOrganizationName: | IONIA PEDIATRIC & ADOLESCENT SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 E ELM ST | ||||||||
| Address2: | PO BOX 730 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488119693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895843971 | ||||||||
| FaxNumber: | 9895846734 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 E WASHINGTON ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | IONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488462202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165221132 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUSLEPP | ||||||||
| AuthorizedOfficialFirstName: | NATALIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF MEDICAL SERVICES GROUP | ||||||||
| AuthorizedOfficialTelephone: | 9895843971 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.