Healthcare Provider Details

I. General information

NPI: 1508908567
Provider Name (Legal Business Name): SPECTRUM HEALTH UNITED MEMORIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S BOWER ST
GREENVILLE MI
48838-2614
US

IV. Provider business mailing address

615 S BOWER ST
GREENVILLE MI
48838-2614
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-4341
  • Fax: 616-754-2270
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number5301001242
License Number StateMI

VIII. Authorized Official

Name: MRS. MARY ANNE JONES
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 616-754-4341