Provider Demographics
NPI:1396878773
Name:NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STASIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-924-1340
Mailing Address - Street 1:78 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:MI
Mailing Address - Zip Code:49421-5100
Mailing Address - Country:US
Mailing Address - Phone:231-854-6415
Mailing Address - Fax:231-854-6975
Practice Address - Street 1:78 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:MI
Practice Address - Zip Code:49421-5100
Practice Address - Country:US
Practice Address - Phone:231-854-6415
Practice Address - Fax:231-854-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26203Medicare UPIN
MI233990Medicare PIN