Healthcare Provider Details

I. General information

NPI: 1376597385
Provider Name (Legal Business Name): SPECTRUM HEALTH SAINT MARYS SHARED TECHNOLOGY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3264 NORTH EVERGREEN DR
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

3264 NORTH EVERGREEN DR
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-6002
  • Fax:
Mailing address:
  • Phone: 616-391-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC A CHIRCOP
Title or Position: VP AMBULATORY SERVICES
Credential:
Phone: 616-391-2796