Healthcare Provider Details

I. General information

NPI: 1023259249
Provider Name (Legal Business Name): SPECTRUM HEALTH PRIMARY CARE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 KALAMAZOO AVE SE SUITE 104
GRAND RAPIDS MI
49508-4600
US

IV. Provider business mailing address

PO BOX 2864
GRAND RAPIDS MI
49501-2864
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704173499
License Number StateMI

VIII. Authorized Official

Name: JAMES TUCCI
Title or Position: PRESIDENT
Credential:
Phone: 616-391-2062