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General NPI Number Information
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NPI Number | 1043288467
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Entity Type | Organization
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Legal Business Name | GRAND RIVER ENDOSCOPY CENTER, L.L.C.
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 310 LAFAYETTE AVE SE SUITE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4693
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Country | US
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Telephone | 616-752-5890
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Fax |
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Provider Business Mailing Address
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Address Line | 310 LAFAYETTE AVE SE SUITE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4693
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Country | US
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Telephone | 616-752-5890
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Fax |
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Authorized Official
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Title or Position | ACCESS ASC BILLING TEAM LEAD
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Name | HOLLY SUND
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Credential |
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Telephone | 616-685-7174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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