Healthcare Provider Details

I. General information

NPI: 1447358304
Provider Name (Legal Business Name): SPECTRUM HEALTH HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5378 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1053
US

IV. Provider business mailing address

80 68TH STREET NE
GRAND RAPIDS MI
49548-6980
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-6230
  • Fax: 616-391-6237
Mailing address:
  • Phone: 616-391-8201
  • Fax: 616-391-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MARC A CHIRCOP
Title or Position: VP AMBULATORY SERVICES
Credential:
Phone: 616-391-2796