Provider Demographics
NPI:1457355851
Name:BRONSN LAKEVIEW HOSPITAL
Entity Type:Organization
Organization Name:BRONSN LAKEVIEW HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT , FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-341-7654
Mailing Address - Street 1:822 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1215
Mailing Address - Country:US
Mailing Address - Phone:269-657-2800
Mailing Address - Fax:269-657-1676
Practice Address - Street 1:822 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1215
Practice Address - Country:US
Practice Address - Phone:269-657-2800
Practice Address - Fax:269-657-1676
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRONSON LAKEVIEW HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-13
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15905251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI153336809Medicaid
MI0E154OtherBCBSM PROVIDER ID
MI153336809Medicaid
MI153336809Medicaid
MI237296Medicare PIN