Organization
LAKESHORE COMMUNITY HOSPITAL, INC.
Active
Parent organization
MERCY HEATLH PARTNERS LAKESHORE CAMPUS
Other names
Hart Family Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERCY HEATLH PARTNERS LAKESHORE CAMPUS
Authorized official
YARA VILLANUEVA (CLINIC REIMBURSEMENT COORDINATOR)
(231) 873-5675
Entity
Organization
Contact information
Practice address
611 E MAIN ST, HART, MI 49420-1190
(231) 873-5675
(231) 873-1825
Mailing address
611 E MAIN ST, HART, MI 49420-1190
(231) 873-5675
(231) 873-1825
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
AB033570
MI
207Q00000X
Family Medicine Physician
PW011554
MI
207Q00000X
Family Medicine Physician
Primary
RO009698
MI
363A00000X
Physician Assistant
CU005544
MI
363A00000X
Physician Assistant
JT003148
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F40011
BCBS
—
05
—
2963232
—
MI
05
—
3015197
—
MI
Enumeration date
04/10/2012
Last updated
04/24/2013
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