LAKELAND COMMUNITY HOSPITAL WATERVLIET NPI 1083710701

NPI Information

NPI: 1083710701
Provider Name: LAKELAND COMMUNITY HOSPITAL WATERVLIET

Doing Business As: COREWELL HEALTH WATERVLIET HOSPITAL PRIMARY CARE - COLOMA

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
6701 PAW PAW AVE
COLOMA, MI
ZIP 49038
Phone: (269) 468-6430
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LAKELAND COMMUNITY HOSPITAL WATERVLIET is a rural health clinic center in Coloma, MI. LAKELAND COMMUNITY HOSPITAL WATERVLIET NPI is 1083710701. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Corewell Health Watervliet Hospital Primary Care - Coloma.

The provider's business location address is:

6701 PAW PAW AVE
COLOMA, MI
ZIP 49038-519
Phone: (269) 468-6430
Fax: (269) 468-0013

The provider's authorized official is Matt Cox .
The authorized official title is Cfo and has the following contact phone number (616) 391-0780.

The CLIA number assigned to this NPI record is 23D0931818 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/16/2006 and was last updated on 4/1/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine				No
2	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	700A110160	OTHER	MICHIGAN	BCBSM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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