Provider Demographics
NPI:1255331583
Name:MGH FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:MGH FAMILY HEALTH CENTER
Other - Org Name:MUSKEGON FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:231-733-4800
Mailing Address - Street 1:2201 S GETTY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1207
Mailing Address - Country:US
Mailing Address - Phone:231-767-9806
Mailing Address - Fax:231-737-1808
Practice Address - Street 1:2201 S GETTY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1207
Practice Address - Country:US
Practice Address - Phone:231-767-9806
Practice Address - Fax:231-737-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F11016OtherBCBSM GROUP ID NUMBER
MI0P04040Medicare ID - Type UnspecifiedNURSE PRACTIONER
MI700F11016OtherBCBSM GROUP ID NUMBER
MI0P09180Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER
MI0M32670Medicare ID - Type UnspecifiedPHYSICIAN GROUP ID NUMBER
MI231859Medicare Oscar/Certification
MI231869Medicare Oscar/Certification
MI0N86850Medicare ID - Type UnspecifiedPHYSICIAN ASSISTANTS