Provider Demographics
NPI:1528007952
Name:MECOSTA HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:MECOSTA HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-592-4217
Mailing Address - Street 1:650 LINDEN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1879
Mailing Address - Country:US
Mailing Address - Phone:231-796-3200
Mailing Address - Fax:231-796-5562
Practice Address - Street 1:650 LINDEN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1879
Practice Address - Country:US
Practice Address - Phone:231-796-3200
Practice Address - Fax:231-796-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X, 208800000X
MI5601004630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG02835OtherBCN/BLUE CHOICE GROUP NUM
MI700E44551OtherBCBS GROUP NUMBER
MIG02835OtherBCN/BLUE CHOICE GROUP NUM
MI0M01220Medicare PIN
MI0N97050Medicare PIN