Provider Demographics
NPI:1619059458
Name:HARBOR BEACH COMMUNITY HOSPITAL INC
Entity Type:Organization
Organization Name:HARBOR BEACH COMMUNITY HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-479-3201
Mailing Address - Street 1:210 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1236
Mailing Address - Country:US
Mailing Address - Phone:989-479-3201
Mailing Address - Fax:989-479-5000
Practice Address - Street 1:210 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-1236
Practice Address - Country:US
Practice Address - Phone:989-479-3201
Practice Address - Fax:989-479-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078947207Q00000X
MI4301067040207Q00000X
MI4301076866207QG0300X
MI5101013107207R00000X
MI5601004034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104643573Medicaid
MI114638537Medicaid
MI104684941Medicaid
MI104700007Medicaid
MI104684941Medicaid
MI231313Medicare PIN