Healthcare Provider Details

I. General information

NPI: 1376868372
Provider Name (Legal Business Name): AMC MOBILE ANESTHESIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 EVERGREEN DR NE
GRAND RAPIDS MI
49525-9493
US

IV. Provider business mailing address

3333 EVERGREEN DR NE
GRAND RAPIDS MI
49525-9493
US

V. Phone/Fax

Practice location:
  • Phone: 616-284-3180
  • Fax: 616-284-3181
Mailing address:
  • Phone: 616-284-3180
  • Fax: 616-284-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES F VANDAM
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 616-284-3100