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1061 Washington Ave Holland MI 49423-5216 | |
(616) 393-8100 | |
(877) 451-0226 |
Full Name | |
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Speciality | Family Medicine |
Location | 1061 Washington Ave, Holland, Michigan |
Authorized Official Name and Position | Diane C Eddington (OFFICE MGR) |
Authorized Official Contact | 6163938100 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1061 Washington Ave Holland MI 49423-5216 Ph: (616) 393-8100 | 1061 Washington Ave Holland MI 49423-5216 Ph: (616) 393-8100 |
NPI Number | 1760156046 |
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Provider Enumeration Date | 08/02/2021 |
Last Update Date | 05/20/2022 |
Medicare PECOS PAC ID | 7315331964 |
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Medicare Enrollment ID | O20220225000509 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760156046 | NPI | - | NPPES |
900149064 | Other | MI | PRIORITY HEALTH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Shaena Freeman |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1023490943 PECOS PAC ID: 5193030476 Enrollment ID: I20180719001220 |
Provider Name | Katelin Elizabeth Dekker |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477187813 PECOS PAC ID: 4981024478 Enrollment ID: I20201022001851 |
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