| Hackley Community Care Center Inc | |
|
2700 Baker St 3rd Floor Muskegon MI 49444-2157 | |
| (231) 737-1335 | |
| (231) 737-0534 |
| Full Name | Hackley Community Care Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2700 Baker St, Muskegon, Michigan |
| Authorized Official Name and Position | Wayne H Kohn (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2317371335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hackley Community Care Center Inc 2700 Baker St 3rd Floor Muskegon MI 49444-2157 Ph: (231) 737-1335 | Hackley Community Care Center Inc 2700 Baker St 3rd Floor Muskegon MI 49444-2157 Ph: (231) 737-1335 |
| NPI Number | 1629066238 |
|---|---|
| Provider Enumeration Date | 10/07/2005 |
| Last Update Date | 11/24/2010 |
| Medicare PECOS PAC ID | 8123015492 |
|---|---|
| Medicare Enrollment ID | O20040511001126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629066238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Susan C Fabrick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891704599 PECOS PAC ID: 5395643092 Enrollment ID: I20031219000295 |
| Provider Name | Byron L Varnado |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962405357 PECOS PAC ID: 3678471992 Enrollment ID: I20031223000718 |
| Provider Name | Nidia O Miedema |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841306065 PECOS PAC ID: 5890774939 Enrollment ID: I20040714000466 |
| Provider Name | Margaret-elizabeth R Wolter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447251442 PECOS PAC ID: 4981660461 Enrollment ID: I20041207000140 |
| Provider Name | Maryanne Louise Kowalski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487736005 PECOS PAC ID: 2264459924 Enrollment ID: I20051101000644 |
| Provider Name | Ann M Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477615342 PECOS PAC ID: 0244335834 Enrollment ID: I20070410000132 |
| Provider Name | Jennifer A Hultman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750597027 PECOS PAC ID: 8527156439 Enrollment ID: I20071109000533 |
| Provider Name | Karen A Thornburg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003938119 PECOS PAC ID: 3375697337 Enrollment ID: I20090811000328 |
| Provider Name | Frank Remington Sprague |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134120108 PECOS PAC ID: 8022141274 Enrollment ID: I20100809000620 |
| Provider Name | Theresa E Marshall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629117734 PECOS PAC ID: 7315120144 Enrollment ID: I20110331000533 |
| Provider Name | Amy L Dzikowicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316385768 PECOS PAC ID: 9638303993 Enrollment ID: I20130930000279 |
| Provider Name | Elizabeth K Rykse |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1649612433 PECOS PAC ID: 2365678976 Enrollment ID: I20131203001322 |
| Provider Name | Julie R Escareno |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659502110 PECOS PAC ID: 9739318015 Enrollment ID: I20140207000701 |
| Provider Name | Stacey M Steeno |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1356724702 PECOS PAC ID: 6305150152 Enrollment ID: I20150806012028 |
| Provider Name | Leslie N Kingsley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043579014 PECOS PAC ID: 2567772163 Enrollment ID: I20151111001696 |
| Provider Name | Tyson J Lahti |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477814846 PECOS PAC ID: 8123310273 Enrollment ID: I20160711000264 |
| Provider Name | Marco John Tatangelo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477992147 PECOS PAC ID: 5193956712 Enrollment ID: I20160829002927 |
| Provider Name | Sara Strait |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538511621 PECOS PAC ID: 1355637067 Enrollment ID: I20160907000431 |
| Provider Name | Tatiana M Michura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649755984 PECOS PAC ID: 9032463989 Enrollment ID: I20181113002521 |
| Provider Name | Mary Tyler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780805051 PECOS PAC ID: 4587095393 Enrollment ID: I20200512000612 |
| Provider Name | Samara A Champion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104407691 PECOS PAC ID: 6103221312 Enrollment ID: I20210826002055 |
| Provider Name | Bradley A Martino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194216218 PECOS PAC ID: 6002209707 Enrollment ID: I20220201001666 |
| Provider Name | Melissa Marie Wynsma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679245401 PECOS PAC ID: 3476947383 Enrollment ID: I20220218000466 |
| Provider Name | Lady Yohanna Rau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841840303 PECOS PAC ID: 7113301706 Enrollment ID: I20220831000930 |
| Provider Name | Joshua John Joshua |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1467464800 PECOS PAC ID: 2264806603 Enrollment ID: I20230324002561 |
| Provider Name | Keith Abraham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669098810 PECOS PAC ID: 0749646784 Enrollment ID: I20230518000251 |
| Provider Name | Gabriel Angelo Devivo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457989428 PECOS PAC ID: 4880055599 Enrollment ID: I20230727002932 |
Hackley Community Care Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 180 E Laketon Ave Ste A, Muskegon, MI 49441 Phone: 231-737-1335 | |
Hackley Weight Management Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5969 Harvey St, Muskegon, MI 49444 Phone: 231-798-1662 Fax: 231-798-8262 | |
Mercy Physician Network Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2006 Holton Rd, Muskegon, MI 49445 Phone: 231-672-3333 | |
Hpcn Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 986 W Norton Ave, Muskegon, MI 49441 Phone: 231-737-2194 Fax: 231-737-4524 | |
Hackley Hosp Wound Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1700 Clinton St, Muskegon, MI 49442 Phone: 231-728-5667 Fax: 231-728-5954 | |
Oakridge Lower Elementary School Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 120 N Park St Ste A, Muskegon, MI 49442 Phone: 231-788-7600 | |
Trinity Health Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1560 E Sherman Blvd Ste 250, Muskegon, MI 49444 Phone: 231-675-8145 Fax: 231-672-6179 |