Healthcare Provider Details

I. General information

NPI: 1114230307
Provider Name (Legal Business Name): GRAND RAPIDS MEDICAL EDUCATION PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONROE AVE NORTHWEST GRAND RAPIDS MEDICAL EDUCATION PARTNERS
GRAND RAPIDS MI
49503-1455
US

IV. Provider business mailing address

1000 MONROE AVE NORTHWEST GRAND RAPIDS MEDICAL EDUCATION PARTNERS
GRAND RAPIDS MI
49503-1455
US

V. Phone/Fax

Practice location:
  • Phone: 616-732-6200
  • Fax: 616-732-6255
Mailing address:
  • Phone: 616-732-6200
  • Fax: 616-732-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4301096078
License Number StateMI

VIII. Authorized Official

Name: SUSAN GRICE
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 616-391-3245