Provider Demographics
NPI:1578748828
Name:MGH FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:MGH FAMILY HEALTH CENTER
Other - Org Name:MUSKEGON FAMILY CARE FAMILY PLANNING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:231-733-4800
Mailing Address - Street 1:1700 OAK AVE
Mailing Address - Street 2:SUITE 011
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-2407
Mailing Address - Country:US
Mailing Address - Phone:231-767-9806
Mailing Address - Fax:
Practice Address - Street 1:1836 OAK AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2408
Practice Address - Country:US
Practice Address - Phone:231-773-3828
Practice Address - Fax:231-737-8262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MGH FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M32670OtherMEDICARE PTAN