Provider Demographics
NPI:1013262468
Name:OAKLAND PHYSICIANS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:OAKLAND PHYSICIANS MEDICAL CENTER, LLC
Other - Org Name:PONTIAC GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCZOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-857-7200
Mailing Address - Street 1:461 W HURON STREET
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-857-7200
Mailing Address - Fax:248-857-6842
Practice Address - Street 1:461 W HURON STREET
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-857-7200
Practice Address - Fax:248-857-6842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5435510Medicaid
MI5435510Medicaid
MI230013Medicare PIN