Healthcare Provider Details

I. General information

NPI: 1629684386
Provider Name (Legal Business Name): TRUE WOMEN'S CLINIC OF GRAND RAPIDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 E PARIS AVE SE STE 230
GRAND RAPIDS MI
49546-6111
US

IV. Provider business mailing address

2144 E PARIS AVE SE STE 230
GRAND RAPIDS MI
49546-6111
US

V. Phone/Fax

Practice location:
  • Phone: 616-330-1700
  • Fax: 616-330-1709
Mailing address:
  • Phone: 616-330-1700
  • Fax: 616-330-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLYN LEBSTER
Title or Position: CEO
Credential:
Phone: 616-330-1700