Provider Demographics
NPI:1639144231
Name:HOLLAND MEDICENTER
Entity Type:Organization
Organization Name:HOLLAND MEDICENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-392-9770
Mailing Address - Street 1:175 S WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7907
Mailing Address - Country:US
Mailing Address - Phone:616-392-5222
Mailing Address - Fax:616-392-3653
Practice Address - Street 1:175 S WAVERLY RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7907
Practice Address - Country:US
Practice Address - Phone:616-392-5222
Practice Address - Fax:616-392-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101117840208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700G06230OtherHMC BCBSMI
MI=========Medicaid
MI0M95120Medicare ID - Type UnspecifiedHMC GROUP MEDICARE
MI=========Medicaid