Healthcare Provider Details

I. General information

NPI: 1083239974
Provider Name (Legal Business Name): MERCY HEALTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 PARCHMENT DR SE STE 210
GRAND RAPIDS MI
49546-2307
US

IV. Provider business mailing address

826 PARCHMENT DR SE STE 210
GRAND RAPIDS MI
49546-2307
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-7930
  • Fax: 616-685-7939
Mailing address:
  • Phone: 616-685-7930
  • Fax: 616-685-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BETTY ELLER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 231-672-2120