Provider Demographics
NPI:1548266778
Name:NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STASIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-924-1340
Mailing Address - Street 1:212 S SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412
Mailing Address - Country:US
Mailing Address - Phone:231-924-1300
Mailing Address - Fax:231-924-1320
Practice Address - Street 1:212 S SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412
Practice Address - Country:US
Practice Address - Phone:231-924-1300
Practice Address - Fax:231-924-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI620010367500000X
MI282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NR1301XHospitalsGeneral Acute Care HospitalRuralGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI301557097Medicaid
MI423OtherPRIORITY HEALTH
MI00088OtherBCBSM
MI9451Medicaid
MI405170667Medicaid
MI230106Medicare PIN
MI00088OtherBCBSM
MI23S106Medicare Oscar/Certification
MI=========000Medicaid
MI00088OtherBCBSM
MI23S106Medicare Oscar/Certification