Provider Demographics
NPI:1972589489
Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Entity Type:Organization
Organization Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Other - Org Name:SPECTRUM HEALTH LUDINGTON HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MARKET LEADER
Authorized Official - Prefix:MR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-924-1340
Mailing Address - Street 1:1 N ATKINSON DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1906
Mailing Address - Country:US
Mailing Address - Phone:231-843-2591
Mailing Address - Fax:231-845-3696
Practice Address - Street 1:1 N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-843-2591
Practice Address - Fax:231-845-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
MI530010282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E36002OtherMEDICARE PART B
MI5171299Medicaid
MI1556026Medicaid
MI23U110Medicare Oscar/Certification
MI5171299Medicaid