Organization
HPCN
Active
Parent organization
MERCY HEALTH PARTNERS
Other names
LAKES FAMILY MEDICINE
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERCY HEALTH PARTNERS
Authorized official
THOMAS REYNOLDS (SENIOR DIRECTOR OF NETWORK ADMIN)
(231) 672-6470
Entity
Organization
Contact information
Practice address
6207 HARVEY ST, STE A, MUSKEGON, MI 49444-9739
(231) 799-2515
(231) 799-2618
Mailing address
PO BOX 1148, MUSKEGON, MI 49443-1148
(231) 727-4444
(231) 727-4451
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080F111420
BCBSM
MI
Enumeration date
07/05/2006
Last updated
01/06/2009
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