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Organization
GEORGETOWN MEDICAL CENTER LLC
Active
Organization
GEORGETOWN MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY LUGTHART M.D. (PRESIDENT)
(616) 457-4610
Entity
Organization
Contact information
Practice address
670 BALDWIN ST, JENISON, MI 49428-9757
(616) 457-4610
(616) 457-8750
Mailing address
670 BALDWIN ST, JENISON, MI 49428-9757
(616) 457-4610
(616) 457-8750
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700D160370
BCBS
—
Enumeration date
04/03/2007
Last updated
05/24/2012
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