Provider Demographics
NPI:1538383351
Name:BRONSON LAKEVIEW HOSPITAL
Entity type:Organization
Organization Name:BRONSON LAKEVIEW HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-341-7654
Mailing Address - Street 1:110 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:MI
Mailing Address - Zip Code:49067-8523
Mailing Address - Country:US
Mailing Address - Phone:269-646-5004
Mailing Address - Fax:269-646-6002
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:MI
Practice Address - Zip Code:49067-8523
Practice Address - Country:US
Practice Address - Phone:269-646-5004
Practice Address - Fax:269-646-6002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRONSON LAKEVIEW HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
MI80-0041282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI238585Medicare Oscar/Certification
MI238585Medicare PIN