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Organization
PENNOCK HOSPITAL
Active
Organization
PENNOCK HOSPITAL
Active
Other names
Specialist Group
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT DAVIS (DIRECTOR OF OPERATIONS)
(269) 945-1220
Entity
Organization
Contact information
Practice address
1009 W GREEN STREET, HASTINGS, MI 49058-1710
(269) 945-1212
(269) 948-3117
Mailing address
1009 W GREEN STREET, HASTINGS, MI 49058-1710
(269) 945-1212
(269) 948-3117
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MI43039857
MI
207R00000X
Internal Medicine Physician
Primary
MI43051816
MI
207R00000X
Internal Medicine Physician
MI43075340
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA9744
MCR RR
MI
Enumeration date
04/24/2007
Last updated
05/12/2016
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