Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Pennock Hospital Board of Trustees

Organization Family Medicine Physician · NPI 1104291202

Pennock Hospital Board of Trustees is a Family Medicine Physician in Ionia, Michigan. Registered with an NPI since 2015.

In the registry since
2015
Specialties on file
4

Practice location Address checks out

2776 S State Rd
Ionia, MI 48846-8472
Phone: (616) 486-6790
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Internal Medicine Physician Taxonomy 207R00000X
Physician Assistant Taxonomy 363A00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1104291202
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationPennock Hospital Board of Trustees
Authorized official Connie Downs — Vp Finance · (269) 948-3122
NPI enumeratedDecember 1, 2015
Last updated in NPPESJanuary 25, 2016
Mailing address100 Michigan St Ne, Mc 845, Grand Rapids, MI 49503-2560

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