BRONSON SOUTH HAVEN HOSPITAL (NPI# 1174749170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174749170 |
| Entity Type | Organization |
| Organization Name | BRONSON SOUTH HAVEN HOSPITAL |
| Other Organization Name | BRONSON MEDICAL GROUP |
| Practice Address |
950 S Bailey Ave South Haven MI 49090-8744 |
| Mailing Address |
601 John St Box 42 Kalamazoo MI 49007-5341 |
| Practice Telephone | 2696375271 |
| Practice Fax Number | 2696392818 |
| Mailing Telephone | 2693418419 |
| Mailing Fax Number | 2693418913 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-09-17 |
| Authorized Official Name | MS. REBECCA L EAST (SVP, CFO) |
| Authorized Official Telephone | 2693416000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities | ||
| N | 282N00000X | General Acute Care Hospital | 800020 | MI | Hospitals |
| Y | 207Q00000X | Family Medicine | 1060000042 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | LICENSE NUMBER | 800020 | 01 |
| MI | BCBS GROUP NUMBER | 700H06003 | 01 |
| Other Name | Type Code |
|---|---|
| Bronson Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902149818 | Bronson South Haven Hospital | Emergency Medicine | 970 S Bailey Ave, South Haven, MI 49090 | 2013-03-28 |
| 1871104034 | Bronson South Haven Hospital | Family Medicine | 930 Blue Star Hwy, South Haven, MI 49090-7758 | 2020-08-12 |
| 1790261832 | Bronson South Haven Hospital | Emergency Medicine | 970 S Bailey Ave, South Haven, MI 49090 | 2018-07-12 |
| 1407072754 | Bronson South Haven Hospital | Clinic/Center | 965 S Bailey Ave, South Haven, MI 49090-9701 | 2007-04-17 |
| 1467539502 | Bronson South Haven Hospital | Home Health | 955 S Bailey Ave, South Haven, MI 49090-9701 | 2006-11-01 |
| 1770599052 | Bronson South Haven Hospital | Family Medicine | 520 Railroad St, Bangor, MI 49013-1490 | 2006-07-31 |
| 1346275856 | Bronson South Haven Hospital | General Acute Care Hospital | 955 S Bailey Ave, South Haven, MI 49090-9701 | 2006-07-12 |
| Street Address |
950 S BAILEY AVE |
| City | SOUTH HAVEN |
| State | MI |
| Zip Code | 49090-8744 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174177034 | Alisa A Somers | Physical Therapist | 950 S Bailey Ave, South Haven, MI 49090-8744 | 2019-07-30 |
| 1073167805 | Waseem Sheriff Humayoon Sheriff | Physical Therapist | 950 S Bailey Ave, South Haven, MI 49090-8744 | 2019-07-30 |
| 1689227894 | Joseph Deyoung | Occupational Therapist | 950 S Bailey Ave, South Haven, MI 49090-8744 | 2019-07-17 |
| 1164074662 | Sarah Elizabeth Bristol | Physical Therapist | 950 S Bailey Ave, South Haven, MI 49090-8744 | 2019-07-15 |
| 1205488707 | Courtney Dwyer | Physical Therapist | 950 S Bailey Ave, South Haven, MI 49090-8744 | 2019-07-15 |
| 1356561112 | Lisa Kay Bigelow | Nurse Practitioner | 950 S Bailey Ave, South Haven, MI 49090-8744 | 2007-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295234490 | Katara Therapy, LLC | Social Worker | 13560 76th Street, Suite 3, South Haven, MI 49090 | 2018-02-03 |
| 1487022091 | Kevin E. Ferrell | Physician Assistant | 955 S. Bailey Avenue, South Haven, MI 49090 | 2015-09-14 |
| 1942638002 | Birdie Farley | Chore Provider | 26725 M-140 Hwy, South Haven, MI 49090 | 2013-10-28 |
| 1730514910 | Rebecca A. Bennett | Counselor | 1675 Phoenix Road, Suite 9, South Haven, MI 49090 | 2013-09-06 |
| 1902149818 | Bronson South Haven Hospital | Emergency Medicine | 970 S Bailey Ave, South Haven, MI 49090 | 2013-03-28 |
| 1265629927 | Cecilia Liz Vives Vasquez | Physical Therapist | 23701 Red Arrow Hwy, Mattawan, MI 49090 | 2007-09-26 |
| 1518089788 | Donald Jam,es Buckley | Pharmacist | 955 S Bailey, South Haven, MI 49090 | 2007-04-06 |
| 1366568966 | Norman M Maly | Dentist | 05055 Blue Star Hwy, South Haven, MI 49090 | 2007-03-22 |
| 1639264062 | Deborah Sue Distefano | Pharmacy Technician | 512 Phoenix Street, South Haven, MI 49090 | 2006-10-03 |
| 1053357897 | Stephen Earl Tolen | Chiropractor | 325 Superior St., South Haven, MI 49090 | 2006-06-21 |
| Find all providers in zip 49090 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558776690 | Martin J Graber Jr. | Family Medicine | 31 Lincoln Ave, South Haven, MI 49090-7116 | 2014-06-27 |
| 1184608614 | Otto Thomas Lorenz Jr. | Family Medicine | 901 S Bailey Ave, South Haven, MI 49090-9701 | 2005-11-29 |
| 1871104034 | Bronson South Haven Hospital | Family Medicine | 930 Blue Star Hwy, South Haven, MI 49090-7758 | 2020-08-12 |
| 1013321983 | Conor Mullin | Family Medicine | 930 Blue Star Hwy, South Haven, MI 49090-7758 | 2014-06-18 |
| 1083860597 | Arlynne Mildred Eisner | Family Medicine | 955 S Bailey Ave, South Haven, MI 49090-9701 | 2008-08-15 |
| 1811195712 | Ryan Stephen Klanseck | Family Medicine | 930 Blue Star Hwy, South Haven, MI 49090-7758 | 2007-07-03 |
| 1891888293 | Mark G Sobor | Family Medicine | 13560 76th St, Unit 2, South Haven, MI 49090-9483 | 2006-09-30 |
| 1699887125 | Susan Patricia Heinrich | Family Medicine | 930 Blue Star Hwy, South Haven, MI 49090-7758 | 2006-08-31 |
| 1952413403 | South Haven Family Physicians, P.C. | Family Medicine | 930 Blue Star Hwy, South Haven, MI 49090-7758 | 2006-08-31 |
| 1689786154 | David Michael Liscow | Family Medicine | 930 Blue Star Hwy, South Haven, MI 49090-7758 | 2006-08-31 |
| Find all providers in SOUTH HAVEN | ||||
| City | SOUTH HAVEN |
| Zip Code | 49090 |
Please comment or provide details below to improve the information on BRONSON SOUTH HAVEN HOSPITAL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.