Healthcare Provider Details

I. General information

NPI: 1952340911
Provider Name (Legal Business Name): ADVANTAGE HEALTH SAINT MARY'S MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON SE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

PO BOX 776974
CHICAGO IL
60677-6974
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5000
  • Fax:
Mailing address:
  • Phone: 800-494-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DANIEL GREEN
Title or Position: VICE PRESIDENT FINANCE GRAND RAPIDS
Credential:
Phone: 616-685-6709