Provider Demographics
NPI:1508924770
Name:LAKELAND COMMUNITY HOSPITAL WATERVLIET
Entity Type:Organization
Organization Name:LAKELAND COMMUNITY HOSPITAL WATERVLIET
Other - Org Name:COREWELL HEALTH WATERVLIET HOSPITALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-391-0780
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:400 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-9225
Practice Address - Country:US
Practice Address - Phone:269-463-2448
Practice Address - Fax:269-463-5351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COREWELL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-04
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI238605Medicare Oscar/Certification
0N78160Medicare PIN