Provider Demographics
NPI:1568536621
Name:HPCN
Entity Type:Organization
Organization Name:HPCN
Other - Org Name:DRS BRENNEMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-1678
Mailing Address - Street 1:1715 PECK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2507
Mailing Address - Country:US
Mailing Address - Phone:231-722-7128
Mailing Address - Fax:231-722-2598
Practice Address - Street 1:1715 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2507
Practice Address - Country:US
Practice Address - Phone:231-722-7128
Practice Address - Fax:231-722-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N79580Medicare PIN