Healthcare Provider Details

I. General information

NPI: 1437520210
Provider Name (Legal Business Name): CALVIN SPAUD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E. BELTLINE AVE SE SUITE 230
GRAND RAPIDS MI
49506-4304
US

IV. Provider business mailing address

1310 E. BELTLINE AVE SE SUITE 230
GRAND RAPIDS MI
49506-4304
US

V. Phone/Fax

Practice location:
  • Phone: 616-288-3732
  • Fax: 616-288-9857
Mailing address:
  • Phone: 616-288-3732
  • Fax: 616-288-9857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: SALLY VANDERPLOEG
Title or Position: VICE PRESIDENT
Credential:
Phone: 616-288-3732