Healthcare Provider Details

I. General information

NPI: 1508378027
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF GRAND RAPIDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON AVE., SE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

2006 HOGBACK RD STE 5A
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5000
  • Fax:
Mailing address:
  • Phone: 734-263-2395
  • Fax: 734-773-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE HYMES
Title or Position: CEO
Credential:
Phone: 734-263-2390