Provider Demographics
NPI:1114973500
Name:HACKLEY HOSPITAL FISCAL SERVICES
Entity Type:Organization
Organization Name:HACKLEY HOSPITAL FISCAL SERVICES
Other - Org Name:HACKLEY NUTRITIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR PHY NETWORK FINAN SERVI
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-727-4499
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1177
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:5969 HARVEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-8801
Practice Address - Country:US
Practice Address - Phone:231-798-0369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N55440Medicare PIN
MI0P15090Medicare PIN