Healthcare Provider Details

I. General information

NPI: 1093885329
Provider Name (Legal Business Name): MATTHEW THAYER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 REMEMBRANCE RD NW
GRAND RAPIDS MI
49534-7729
US

IV. Provider business mailing address

3305 REMEMBRANCE RD NW
GRAND RAPIDS MI
49534-7729
US

V. Phone/Fax

Practice location:
  • Phone: 616-826-6231
  • Fax: 616-791-4060
Mailing address:
  • Phone: 616-826-6231
  • Fax: 616-791-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberF
License Number StateMI

VIII. Authorized Official

Name: MR. MATTHEW THAYER
Title or Position: OWNER
Credential:
Phone: 616-826-6231