Provider Demographics
NPI:1780679753
Name:ASCENSION BORGESS HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION BORGESS HOSPITAL
Other - Org Name:KALAMAZOO ORTHOPAEDIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-226-4800
Mailing Address - Street 1:1717 SHAFFER STREET
Mailing Address - Street 2:SUITE 002
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048
Mailing Address - Country:US
Mailing Address - Phone:269-552-2830
Mailing Address - Fax:
Practice Address - Street 1:2490 S 11TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2175
Practice Address - Country:US
Practice Address - Phone:269-343-1535
Practice Address - Fax:269-343-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI392110031207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200C976490OtherBCBSM PIN