Provider Demographics
NPI:1033243399
Name:LAKELAND COMMUNITY HOSPITAL WATERVLIET
Entity Type:Organization
Organization Name:LAKELAND COMMUNITY HOSPITAL WATERVLIET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-915-3777
Mailing Address - Street 1:400 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-9225
Mailing Address - Country:US
Mailing Address - Phone:269-983-8300
Mailing Address - Fax:269-463-5351
Practice Address - Street 1:400 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-9225
Practice Address - Country:US
Practice Address - Phone:269-463-3111
Practice Address - Fax:269-463-2237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COREWELL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-16
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30 2885397Medicaid
MI00184OtherBCBSM
MI23T078Medicare Oscar/Certification