Provider Demographics
NPI:1932209350
Name:LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC
Entity Type:Organization
Organization Name:LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-983-8398
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-0410
Mailing Address - Country:US
Mailing Address - Phone:269-428-2574
Mailing Address - Fax:269-428-0490
Practice Address - Street 1:3772 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9550
Practice Address - Country:US
Practice Address - Phone:269-428-7481
Practice Address - Fax:269-428-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110050261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5241025Medicaid
00219OtherBLUE CROSS
232304Medicare Oscar/Certification