Healthcare Provider Details

I. General information

NPI: 1659012037
Provider Name (Legal Business Name): BAMF HEALTH I PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MICHIGAN ST NW STE 200
GRAND RAPIDS MI
49503-3790
US

IV. Provider business mailing address

109 MICHIGAN ST NW STE 200
GRAND RAPIDS MI
49503-3790
US

V. Phone/Fax

Practice location:
  • Phone: 888-870-8998
  • Fax: 616-253-8365
Mailing address:
  • Phone: 888-870-8998
  • Fax: 616-253-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMIAH JOHNS
Title or Position: DIRECTOR
Credential: MD
Phone: 616-916-0774