Healthcare Provider Details

I. General information

NPI: 1417950395
Provider Name (Legal Business Name): GRAND VALLEY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 LEONARD ST NE STE 1
GRAND RAPIDS MI
49525-6902
US

IV. Provider business mailing address

2680 LEONARD ST NE STE 1
GRAND RAPIDS MI
49525-6902
US

V. Phone/Fax

Practice location:
  • Phone: 616-224-1110
  • Fax:
Mailing address:
  • Phone: 616-224-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number416829
License Number StateMI

VIII. Authorized Official

Name: KARA M DUNWOODY
Title or Position: QUALITY AND OPERATIONS MGR
Credential:
Phone: 616-224-1110