Organization
LEE MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH HOLST (CFO)
(269) 783-3034
Entity
Organization
Contact information
Practice address
520 MAIN ST, DOWAGIAC, MI 49047-1762
(269) 783-3052
Mailing address
420 W HIGH ST, DOWAGIAC, MI 49047-1943
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A41004
BCBSM PIN
—
Enumeration date
04/24/2008
Last updated
04/24/2008
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