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General NPI Number Information
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NPI Number | 1043598923
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Entity Type | Organization
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Legal Business Name | GRAND RAPIDS MEDICAL EDUCATION PARTNERS
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 200 JEFFERSON STREET SE SAINT MARY'S HEALTH CARE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1770
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Country | US
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Telephone | 616-710-9370
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Fax |
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Provider Business Mailing Address
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Address Line | 510 COLLEGE AVE NE APT 213
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1770
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Country | US
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Telephone | 616-710-9370
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MARK SPOOLSTRA
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Credential |
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Telephone | 616-391-3775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 4
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License Number State | MI
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