Healthcare Provider Details

I. General information

NPI: 1609769637
Provider Name (Legal Business Name): TAMARIS GALLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 E BELTLINE AVE NE STE 106-1409
GRAND RAPIDS MI
49525-7045
US

IV. Provider business mailing address

1971 E BELTLINE AVE NE STE 1061409
GRAND RAPIDS MI
49525-7045
US

V. Phone/Fax

Practice location:
  • Phone: 980-317-0318
  • Fax:
Mailing address:
  • Phone: 980-317-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: