Healthcare Provider Details

I. General information

NPI: 1902002272
Provider Name (Legal Business Name): TRINITY HEALTH - MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 S DIVISION AVE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

245 STATE ST SE STE 1A
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3800
  • Fax: 616-235-0913
Mailing address:
  • Phone: 616-685-8050
  • Fax: 616-685-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: PHILIP H MCCORKLE JR.
Title or Position: PRESIDENT CEO
Credential:
Phone: 616-685-1808