Provider Demographics
NPI:1306025523
Name:OCEANA COUNTY MEDICAL CARE FACILITY
Entity Type:Organization
Organization Name:OCEANA COUNTY MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-873-6600
Mailing Address - Street 1:701 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-1168
Mailing Address - Country:US
Mailing Address - Phone:231-873-6600
Mailing Address - Fax:231-873-6030
Practice Address - Street 1:701 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-1168
Practice Address - Country:US
Practice Address - Phone:231-873-6600
Practice Address - Fax:231-873-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI648510261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI64-2085114Medicaid
MI30910OtherBCBSM
MI30047OtherBCBSM
MI64-2085114Medicaid