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PENNOCK STATE STREET CENTER
NPI 1932490885
Physician Assistant - Medical in Hastings, MI

Active since April 27, 2011
1108 W STATE ST, HASTINGS, MI 49058(269) 948-3360 Get Directions Write a Review

NPPES record last updated: April 2, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Pennock State Street Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PENNOCK STATE STREET CENTER (NPI 1932490885) is a healthcare organization registered as a medical in Hastings, Michigan and active in the NPI registry since April 2011. The organization lists Amy Poholski, Director, as its authorized official.

NPPES Registry Identity

NPI1932490885
Entity TypeOrganization
Primary Taxonomy363AM0700X
Legal Business NamePENNOCK STATE STREET CENTER
Location Address1108 W STATE STHastings, MI 49058-9711
Mailing Address4100 Embassy Dr Se, Suite 200Grand Rapids, MI 49546-2416 · (616) 975-1845 · Fax (616) 285-0846
Phone(269) 948-3360
Organization SubpartNo
Authorized OfficialAmy PoholskiDirector · (616) 975-1845
Enumeration DateApril 27, 2011
Last NPPES UpdateApril 2, 2019
✔ NPI 1932490885 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
1108 W STATE ST, Hastings, MI 49058
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Other Identifiers 1

Other0Z80041MI · Bcbs

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALIA ANTHONY
Nurse Practitioner
1108 W STATE ST, SUITE 3
HASTINGS, MI 49058
Barry County (269) 945-0922
MRS. TIFFANY R JACKSON NP
Nurse Practitioner
1108 W STATE ST, SUITE 3
HASTINGS, MI 49058
Barry County (269) 945-0922
ADAM FARRELL PA-C
Physician Assistant
1108 W STATE ST
HASTINGS, MI 49058
Barry County (269) 948-3102
LEON VANDERLAAN PA-C
Physician Assistant
1108 W STATE ST
HASTINGS, MI 49058
Barry County (269) 948-3102
PENNOCK HOSPITAL
Clinic/Center (Rural Health)
1108 W STATE ST, SUITE 3
HASTINGS, MI 49058
Barry County (269) 945-0922
PENNOCK HOSPITAL BOARD OF TRUSTEES
Family Medicine
1108 W STATE ST
HASTINGS, MI 49058
Barry County (269) 945-8080
AMBER JUHL NP
Nurse Practitioner (Family)
1108 W STATE ST
HASTINGS, MI 49058
Barry County (269) 948-3360
DR. LAURA J KOTA MD
Obstetrics & Gynecology
1108 W STATE ST, SUITE 3
HASTINGS, MI 49058
Barry County (269) 945-8080

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pennock State Street Center's NPI number?

The NPI number for Pennock State Street Center is 1932490885. It was assigned to this organization in the NPPES registry on April 27, 2011.

Where is Pennock State Street Center located?

Pennock State Street Center is located at 1108 W State St, Hastings, MI 49058. The listed phone number is (269) 948-3360.

What is Pennock State Street Center's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Pennock State Street Center was last updated on April 2, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.