Healthcare Provider Details

I. General information

NPI: 1285830448
Provider Name (Legal Business Name): PROFESSIONAL FINANCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 GRANDVILLE AVE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

245 STATE ST SE STE 1A
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8400
  • Fax: 616-742-1322
Mailing address:
  • Phone: 616-685-8050
  • Fax: 616-685-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: PHILIP H MCCORKLE JR.
Title or Position: PRESIDENT CEO
Credential:
Phone: 616-685-1808