1194771030 NPI number — ASCENSION BORGESS LEE HOSPITAL

Table of content: (NPI 1194771030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194771030 NPI number — ASCENSION BORGESS LEE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
ASCENSION BORGESS LEE HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194771030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 WEST HIGH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWAGIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49047-1943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-783-3089
Provider Business Mailing Address Fax Number:
269-783-3097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 WEST HIGH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWAGIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49047-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-782-8681
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERGMANN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
269-226-4800

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  SFE1414003186 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 1060000082 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1555987 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5171083 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".