| Corewell Health Pennock Hospital Family Medicine - Lake Odessa | |
|
4294 Laurel Dr Lake Odessa MI 48849-8430 | |
| (616) 374-7660 | |
| (616) 374-0270 |
| Full Name | Corewell Health Pennock Hospital Family Medicine - Lake Odessa |
|---|---|
| Speciality | Clinic/Center |
| Location | 4294 Laurel Dr, Lake Odessa, Michigan |
| Authorized Official Name and Position | John Sella (CONTROLLER) |
| Authorized Official Contact | 6168020206 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corewell Health Pennock Hospital Family Medicine - Lake Odessa 100 Michigan St Ne Mc 845 Grand Rapids MI 49503-2560 Ph: () - | Corewell Health Pennock Hospital Family Medicine - Lake Odessa 4294 Laurel Dr Lake Odessa MI 48849-8430 Ph: (616) 374-7660 |
| NPI Number | 1962889584 |
|---|---|
| Provider Enumeration Date | 05/04/2015 |
| Last Update Date | 08/23/2023 |
| Medicare PECOS PAC ID | 4587551015 |
|---|---|
| Medicare Enrollment ID | O20180928001557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962889584 | NPI | - | NPPES |
| 238675 | Other | MI | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Pennock Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4294 Laurel Dr, Lake Odessa, MI 48849 Phone: 616-374-7660 | |
Clarence Richard Barnett Md Plc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1020 4th Ave, Lake Odessa, MI 48849 Phone: 616-374-8881 Fax: 616-374-4220 | |
Brian W Swanton Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4294 Laurel Dr, Lake Odessa, MI 48849 Phone: 616-374-7660 Fax: 616-374-0270 | |
Laurie S Braker Md Plc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4294 Laurel Dr, Lake Odessa, MI 48849 Phone: 616-374-7660 Fax: 616-374-0270 |