Provider Demographics
NPI:1891898847
Name:MGH FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:MGH FAMILY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-739-9315
Mailing Address - Street 1:2201 S GETTY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1207
Mailing Address - Country:US
Mailing Address - Phone:231-737-1706
Mailing Address - Fax:231-737-1814
Practice Address - Street 1:2201 S GETTY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1207
Practice Address - Country:US
Practice Address - Phone:231-737-1706
Practice Address - Fax:231-737-1814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MGH FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2367349Medicaid
MI2367349Medicaid