Healthcare Provider Details

I. General information

NPI: 1275529562
Provider Name (Legal Business Name): SPECTRUM HEALTH HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 68TH ST SE
GRAND RAPIDS MI
49548-6980
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 406
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-8260
  • Fax:
Mailing address:
  • Phone: 616-391-1774
  • Fax: 616-774-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number416822
License Number StateMI

VIII. Authorized Official

Name: MR. DOUGLAS D WELDAY
Title or Position: VP FINANCE
Credential:
Phone: 616-391-2525