Healthcare Provider Details

I. General information

NPI: 1962933416
Provider Name (Legal Business Name): TRINITY HEALTH-MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 MADISON AVE SE
GRAND RAPIDS MI
49507-1761
US

IV. Provider business mailing address

245 STATE ST SE STE 1A
GRAND RAPIDS MI
49503-4348
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH A. MURPHY
Title or Position: VP, CNO
Credential:
Phone: 616-685-6411