Provider Demographics
NPI:1871777227
Name:FOUR FLAGS HEALTH VENTURES,INC
Entity type:Organization
Organization Name:FOUR FLAGS HEALTH VENTURES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.OPERATIONS & FACILITY MANAGEMEN
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-938-8399
Mailing Address - Street 1:122 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2281
Mailing Address - Country:US
Mailing Address - Phone:269-684-0259
Mailing Address - Fax:269-684-0189
Practice Address - Street 1:122 GRANT ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2281
Practice Address - Country:US
Practice Address - Phone:269-684-0259
Practice Address - Fax:269-684-0189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKELAND REGIONAL HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization