Provider Demographics
NPI:1609034552
Name:PREMIER HOSPITAL MEDICINE SPECIALISTS PC
Entity Type:Organization
Organization Name:PREMIER HOSPITAL MEDICINE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANHAPRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-780-6060
Mailing Address - Street 1:PO BOX 1222
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1222
Mailing Address - Country:US
Mailing Address - Phone:231-780-6060
Mailing Address - Fax:231-780-6093
Practice Address - Street 1:750 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1918
Practice Address - Country:US
Practice Address - Phone:231-780-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty