Provider Demographics
NPI:1871097782
Name:WEST SHORE OTOLARYNGOLOGY PC
Entity type:Organization
Organization Name:WEST SHORE OTOLARYNGOLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:231-739-9095
Mailing Address - Street 1:1450 FARR RD STE 5000
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7789
Mailing Address - Country:US
Mailing Address - Phone:231-739-9095
Mailing Address - Fax:231-722-5147
Practice Address - Street 1:16760 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417
Practice Address - Country:US
Practice Address - Phone:616-935-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST SHORE OTOLARYNGOLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-23
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty