Provider Demographics
NPI:1386665289
Name:HASTINGS SURGEONS, P.C.
Entity Type:Organization
Organization Name:HASTINGS SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIGHANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPPAPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-948-8411
Mailing Address - Street 1:1005 W GREEN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1712
Mailing Address - Country:US
Mailing Address - Phone:269-948-8411
Mailing Address - Fax:269-948-9874
Practice Address - Street 1:1005 W GREEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1712
Practice Address - Country:US
Practice Address - Phone:269-948-8411
Practice Address - Fax:269-948-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM51290Medicare ID - Type UnspecifiedGROUP NUMBER