Provider Demographics
NPI:1265656086
Name:LAKEVIEW COMMUNITY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:LAKEVIEW COMMUNITY HOSPITAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-341-7654
Mailing Address - Street 1:404 HAZEN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1040
Mailing Address - Country:US
Mailing Address - Phone:269-657-4407
Mailing Address - Fax:269-657-0965
Practice Address - Street 1:404 HAZEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1040
Practice Address - Country:US
Practice Address - Phone:269-657-4407
Practice Address - Fax:269-657-0965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEVIEW COMMUNITY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H06012Medicare PIN
MI231332Medicare Oscar/Certification