Provider Demographics
NPI:1902810740
Name:HPCN
Entity Type:Organization
Organization Name:HPCN
Other - Org Name:HACKLEY LAKES OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BEAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-1676
Mailing Address - Street 1:6401 PRAIRIE ST
Mailing Address - Street 2:2100
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7840
Mailing Address - Country:US
Mailing Address - Phone:231-727-7939
Mailing Address - Fax:231-727-7935
Practice Address - Street 1:6401 PRAIRIE ST
Practice Address - Street 2:2100
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-7840
Practice Address - Country:US
Practice Address - Phone:231-727-7939
Practice Address - Fax:231-727-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN79680Medicare ID - Type UnspecifiedMEDICARE