Healthcare Provider Details

I. General information

NPI: 1699042952
Provider Name (Legal Business Name): SPECTRUM HEALTH HOME MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2001
US

IV. Provider business mailing address

1255 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2001
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-2950
  • Fax:
Mailing address:
  • Phone: 616-486-2950
  • Fax:

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: MARK GUZICKI
Title or Position: VP HOME AND COMMUNITY BASED SVCS
Credential:
Phone: 616-486-3955