1295803377 NPI number — ASCENSION BORGESS ALLEGAN HOSPITAL

Table of content: (NPI 1295803377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295803377 NPI number — ASCENSION BORGESS ALLEGAN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION BORGESS ALLEGAN 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:
1295803377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 SHAFER STREET, SUITE 002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
269-552-2964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 LINN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEGAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49010-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-686-4051
Provider Business Practice Location Address Fax Number:
269-686-4236
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOUGHTON
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
269-226-4800

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  030032 , 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: 024464 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 091971300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807082900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 405170030 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00117 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01411552 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231328 . This is a "HUMANA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 301558020 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 638850700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0273314 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100033860A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11521B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: ALL0042N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113396105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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