Provider Demographics
NPI:1932113388
Name:HPCN
Entity Type:Organization
Organization Name:HPCN
Other - Org Name:HARBOUR VIEW FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR NETWORK ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-672-6740
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1148
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:1909 RUDDIMAN DR
Practice Address - Street 2:
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-3147
Practice Address - Country:US
Practice Address - Phone:231-744-5577
Practice Address - Fax:231-744-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N79600Medicare PIN