Healthcare Provider Details

I. General information

NPI: 1528556750
Provider Name (Legal Business Name): SAINT MARY'S HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 JEFFERSON AVE SE STE 140
GRAND RAPIDS MI
49503-4306
US

IV. Provider business mailing address

150 JEFFERSON AVE SE STE 140
GRAND RAPIDS MI
49503-4306
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3359
  • Fax:
Mailing address:
  • Phone: 616-685-3359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278E1000X
TaxonomyEducational Certified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN LOCKARD
Title or Position: SENIOR REVENUE MANAGEMENT ANALYST
Credential:
Phone: 734-343-0282