Provider Demographics
NPI:1568644052
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:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CATIGNANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:947-522-0536
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:269-463-5351
Practice Address - Street 1:400 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098
Practice Address - Country:US
Practice Address - Phone:269-463-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COREWELL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043583207Q00000X
207Q00000X, 207R00000X, 207X00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M55810Medicare PIN