Healthcare Provider Details

I. General information

NPI: 1811207350
Provider Name (Legal Business Name): SPECTRUM HEALTH PRIMARY CARE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4085 BURTON SE SUITE 102
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

100 MICHIGAN NE MC 845
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-284-8842
  • Fax:
Mailing address:
  • Phone:
  • 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: PAULINE KRYWANSKI
Title or Position: CFO
Credential:
Phone: 616-486-2253