Provider Demographics
NPI:1104901248
Name:PLANNED PARENTHOOD OF WEST & NORTHERN MI
Entity type:Organization
Organization Name:PLANNED PARENTHOOD OF WEST & NORTHERN MI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-774-7005
Mailing Address - Street 1:1205 PECK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2121
Mailing Address - Country:US
Mailing Address - Phone:231-722-2928
Mailing Address - Fax:231-722-4314
Practice Address - Street 1:209 E APPLE AVE
Practice Address - Street 2:MUSKEGON PUBLIC HEALTH BUILDING
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442
Practice Address - Country:US
Practice Address - Phone:231-724-4415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI232797098Medicaid