Organization
ASCENSION MEDICAL GROUP PROMED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARINA HOUGHTON (CFO)
(269) 226-4800
Entity
Organization
Contact information
Practice address
8001 ANGLING RD, PORTAGE, MI 49024-7422
(269) 321-7090
Mailing address
1717 SHAFFER ST STE 2, KALAMAZOO, MI 49048-1623
(269) 552-2836
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
750910577
BCBSM GROUP #
MI
Enumeration date
03/07/2007
Last updated
12/30/2022
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