Organization Name: | VAN BUREN MEDICAL CENTER OF MGC |
NPI Number: | 1235327636 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES B DAVIS (VICE PRESIDENT) |
Mailing Address: | 201 N 1st Street Van Buren |
State: | IN US |
Postal Code: | 49661 |
Phone Number: | 7659349414 |
Fax Number: | 7659349415 |
NPI Enumeration Date: | 10/10/2007 |
NPI Last Update Date: | 10/10/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |