Provider Demographics
NPI:1063625192
Name:WEST SHORE HEALTH CENTERS CORPORATION
Entity type:Organization
Organization Name:WEST SHORE HEALTH CENTERS CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-398-1188
Mailing Address - Street 1:8288 PORTAGE ST
Mailing Address - Street 2:
Mailing Address - City:ONEKAMA
Mailing Address - State:MI
Mailing Address - Zip Code:49675
Mailing Address - Country:US
Mailing Address - Phone:231-889-4283
Mailing Address - Fax:231-889-4484
Practice Address - Street 1:8288 PORTAGE ST
Practice Address - Street 2:
Practice Address - City:ONEKAMA
Practice Address - State:MI
Practice Address - Zip Code:49675
Practice Address - Country:US
Practice Address - Phone:231-889-4283
Practice Address - Fax:231-889-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
MI4704150368363LF0000X
MI261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P29960Medicare PIN
MI0N35110Medicare PIN