# GEORGETOWN MEDICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427170414
- **Authorized official:** DR. JAY LUGTHART M.D. (PRESIDENT)
- **Authorized official phone:** (616) 457-4610

## Contact information

- **Practice address:** 670 BALDWIN ST, JENISON, MI 49428-9757
- **Practice address phone:** (616) 457-4610
- **Practice address fax:** (616) 457-8750
- **Mailing address:** 670 BALDWIN ST, JENISON, MI 49428-9757
- **Mailing address phone:** (616) 457-4610
- **Mailing address fax:** (616) 457-8750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/03/2007
- **Last updated:** 05/24/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 700D160370 | BCBS | — |