PENNOCK HOSPITAL (NPI# 1962889584) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962889584 |
| Entity Type | Organization |
| Organization Name | PENNOCK HOSPITAL |
| Other Organization Name | SPECTRUM HEALTH PENNOCK FAMILY MEDICINE - LAKE ODESSA |
| Practice Address |
4294 Laurel Dr Lake Odessa MI 48849-8430 |
| Mailing Address |
100 Michigan St Ne Mc 845 Grand Rapids MI 49503-2560 |
| Practice Telephone | 6163747660 |
| Practice Fax Number | 6163740270 |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2016-09-20 |
| Authorized Official Name | DIEDRE WELLER (CONTROLLER) |
| Authorized Official Telephone | 2699483122 |
| Is Organization Subpart | Y |
| Parent Organization Name | PENNOCK HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MEDICARE PTAN | 238675 | 01 |
| Other Name | Type Code |
|---|---|
| Spectrum Health Pennock Family Medicine - Lake Odessa | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023001146 | Pennock Hospital | General Acute Care Hospital | 1009 W Green St, Hastings, MI 49058-1710 | 2005-08-24 |
| 1932695525 | Pennock Hospital | General Acute Care Hospital | 1009 W Green St, Hastings, MI 49058-1710 | 2018-07-06 |
| 1013453760 | Pennock Hospital | Clinic/Center | 490 Edward St, Middleville, MI 49333-9131 | 2017-01-18 |
| 1689127847 | Pennock Hospital | Family Medicine | 490 Edward St, Middleville, MI 49333-9131 | 2016-07-24 |
| 1326495326 | Pennock Hospital | Nurse Practitioner | 9090 S Rodgers Ct Se, Caledonia, MI 49316-8052 | 2016-05-19 |
| 1205281045 | Pennock Hospital | Nurse Practitioner | 12851 W M 179 Hwy, Wayland, MI 49348-9318 | 2016-04-29 |
| 1396190138 | Pennock Hospital | Clinic/Center | 1108 W State St, Suite 3, Hastings, MI 49058-9711 | 2016-04-29 |
| 1841644184 | Pennock Hospital | Clinic/Center | 1005 W Green St, Suite 301, Hastings, MI 49058-1712 | 2016-04-22 |
| 1801250907 | Pennock Hospital | Clinic/Center | 12851 W M 179 Hwy, Wayland, MI 49348-9318 | 2016-04-05 |
| 1275999286 | Pennock Hospital | Family Medicine | 4294 Laurel Dr, Lake Odessa, MI 48849-8430 | 2016-01-06 |
| Street Address |
4294 LAUREL DR |
| City | LAKE ODESSA |
| State | MI |
| Zip Code | 48849-8430 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578580080 | Total Health Center Hastings Inc | Physical Therapist | 4294 Laurel Dr, Ste 2, Lake Odessa, MI 48849 | 2006-07-17 |
| 1215470265 | Zachary Daniel Jones | Physician Assistant | 4294 Laurel Dr, Lake Odessa, MI 48849-8430 | 2016-11-23 |
| 1023562519 | Michelle Vanburen | Nurse Practitioner | 4294 Laurel Dr, Lake Odessa, MI 48849-8430 | 2016-08-12 |
| 1275999286 | Pennock Hospital | Family Medicine | 4294 Laurel Dr, Lake Odessa, MI 48849-8430 | 2016-01-06 |
| 1508269705 | Spectrum Health Primary Care Partners | Internal Medicine | 4294 Laurel Dr, Lake Odessa, MI 48849-8430 | 2014-10-01 |
| 1891105508 | West Michigan Heart | Internal Medicine | 4294 Laurel Dr, Lake Odessa, MI 48849-8430 | 2014-05-02 |
| 1184911836 | Christopher R Shoemaker | Family Medicine | 4294 Laurel Dr, Lake Odessa, MI 48849-8430 | 2011-07-01 |
| 1942509666 | Laurie S Braker Md Plc | Family Medicine | 4294 Laurel Dr, Lake Odessa, MI 48849-8430 | 2011-03-21 |
| 1053635359 | Pennock Hospital Board of Trustees | General Acute Care Hospital | 4294 Laurel Dr, Lake Odessa, MI 48849-8430 | 2010-03-16 |
| 1427216241 | Pine Rest Christian Mental Health Services | Counselor | 4294 Laurel Dr, Lake Odessa, MI 48849-9423 | 2008-05-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851512339 | Christine Margaret Thomas | Pharmacist | 838 Fouth Ave, Lake Odessa, MI 48849 | 2007-05-01 |
| 1275641649 | Advanced Rx LLC | Pharmacy | 838 4th Avenue, Lake Odessa, MI 48849 | 2006-08-27 |
| 1831608108 | Lake Odessa Pharmacy | Pharmacy | 802 4th Ave, Lake Odessa, MI 48849-1002 | 2017-09-29 |
| 1104914001 | William H Walker | Pharmacist | 838 4th Ave, Lake Odessa, MI 48849-1002 | 2006-10-10 |
| 1851340335 | Catherine Hemingway | Dental Hygienist | 924 4th Ave, Lake Odessa, MI 48849-1003 | 2006-05-10 |
| 1639258320 | Aaron Blane Freeman | Dentist | 924 4th Ave, Lake Odessa, MI 48849-1003 | 2006-11-03 |
| 1083133607 | Vicki Davison | Psychologist | 1040 4th Ave, Lake Odessa, MI 48849-1004 | 2017-09-14 |
| 1215024369 | Gerald T Licari Dds PC | Dentist | 1032 4th Ave, Lake Odessa, MI 48849-1004 | 2006-10-09 |
| 1558320846 | Clarence Richard Barnett | Family Medicine | 1020 4th Ave, Lake Odessa, MI 48849-1004 | 2006-03-23 |
| 1851889471 | Lake Odessa Dental, Pllc | Clinic/Center | 1032 4th Ave, Lake Odessa, MI 48849-1004 | 2018-04-30 |
| Find all providers in zip 48849 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1932747946 | Mckenzie Memorial Hospital | Clinic/Center | 170 W Argyle Street, Sandusky, MI 48471 | 2019-12-20 |
| 1326681461 | Munson Healthcare Charlevoix Hospital | Clinic/Center | 14719 W Upright St, Charlevoix, MI 49720-1949 | 2019-10-22 |
| 1881254605 | Schoolcraft Memorial Hospital | Clinic/Center | W11650 Us Highway 2, Naubinway, MI 49762-5116 | 2019-06-14 |
| 1093370264 | Samaritan Health Care, PC | Clinic/Center | 4361 220th Ave, Reed City, MI 49677-8594 | 2019-05-03 |
| 1457916637 | Samaritan Health Care, PC | Clinic/Center | 5916 Us Highway 31 S, Charlevoix, MI 49720-9703 | 2019-05-03 |
| 1033621263 | Caro Community Hospital | Clinic/Center | 345 N State St, Caro, MI 48723-1537 | 2017-10-27 |
| 1275050726 | Hills & Dales General Hospital, Inc. | Clinic/Center | 130 Millwood Street, Caro, MI 48723-1630 | 2017-08-25 |
| 1275932329 | Sturgis Hospital, Inc. | Clinic/Center | 111 S Saint Joseph St, Colon, MI 49040-9342 | 2014-08-14 |
| Find all providers with the same taxonomy | ||||
| City | LAKE ODESSA |
| Zip Code | 48849 |
Please comment or provide details below to improve the information on PENNOCK 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.