Provider Demographics
NPI:1497978928
Name:PARAGON HEALTH PC
Entity Type:Organization
Organization Name:PARAGON HEALTH PC
Other - Org Name:HALLER ROWE HAVILAND OPHTHALMOLOGY DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-341-4554
Mailing Address - Street 1:1052 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1734
Mailing Address - Country:US
Mailing Address - Phone:269-343-1684
Mailing Address - Fax:269-343-5375
Practice Address - Street 1:1052 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1734
Practice Address - Country:US
Practice Address - Phone:269-343-1684
Practice Address - Fax:269-343-5375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARAGON HEALTH PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-11
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1222380001Medicare NSC