Provider Demographics
NPI:1609011923
Name:IONIA COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:IONIA COUNTY MEMORIAL HOSPITAL
Other - Org Name:FHC-PORTLAND RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-523-1400
Mailing Address - Street 1:9751 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-9774
Mailing Address - Country:US
Mailing Address - Phone:517-647-6722
Mailing Address - Fax:517-647-6838
Practice Address - Street 1:9751 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875-9774
Practice Address - Country:US
Practice Address - Phone:517-647-6722
Practice Address - Fax:517-647-6838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IONIA COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-16
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI340021261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health