Organization
PORTAGE HEALTH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES BOGAN (PRESIDENT/CEO)
(906) 483-1500
Entity
Organization
Contact information
Practice address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1000
Mailing address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1000
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C16002
PROFESSIONAL GROUP
MI
05
—
2988984
—
MI
01
—
540C106010
BLUE CROSS BLUE SHIELD
MI
Enumeration date
04/16/2008
Last updated
07/26/2013
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