Provider Demographics
NPI:1720232697
Name:HOLLAND COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:HOLLAND COMMUNITY HOSPITAL
Other - Org Name:HOLLAND HOSPITAL INTERNAL MEDICINE - NORTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-394-3456
Mailing Address - Street 1:3235 N WELLNESS DR STE 120B
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8035
Mailing Address - Country:US
Mailing Address - Phone:616-399-9522
Mailing Address - Fax:616-738-7858
Practice Address - Street 1:3235 N WELLNESS DR STE 120B
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8035
Practice Address - Country:US
Practice Address - Phone:616-399-9522
Practice Address - Fax:616-738-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062113207R00000X
207R00000X, 207R00000X
MI5901001716213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6207460001Medicare NSC