Provider Demographics
NPI:1184912396
Name:MECOSTA COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:MECOSTA COUNTY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-349-1616
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:14755 215TH AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9224
Practice Address - Country:US
Practice Address - Phone:231-796-3200
Practice Address - Fax:231-796-5562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MECOSTA COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-21
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI238652Medicare Oscar/Certification