1780341784 NPI number — HOLLAND FOOT AND ANKLE CENTER PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780341784 NPI number — HOLLAND FOOT AND ANKLE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLLAND FOOT AND ANKLE CENTER PC
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:
1780341784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49423-7724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-392-7472
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S STATE ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEELAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49464-1677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-392-7472
Provider Business Practice Location Address Fax Number:
616-392-3327
Provider Enumeration Date:
11/24/2021

Additional Information

Authorized Official

Authorized Official Last Name:
VENEMA
Authorized Official First Name:
DEB
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
616-392-7472

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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