1003353640 NPI number — HOLLAND FOOT AND ANKLE CENTER, PC

Table of content: (NPI 1003353640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003353640 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:
1003353640
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:
616-392-3327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
551 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:
49010-1595
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:
01/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VAN TIL
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
616-392-7472

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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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