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General NPI Number Information
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NPI Number | 1114929353
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Entity Type | Organization
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Legal Business Name | GRAND RIVER EMERGENCY MEDICAL GROUP PLC
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 200 JEFFERSON AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4502
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Country | US
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Telephone | 616-685-6781
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX Q
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City | GRAND RAPIDS
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State | MI
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Zip | 49501-4917
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Country | US
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Telephone | 800-968-6866
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Fax | 616-532-7230
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Authorized Official
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Title or Position | PRESIDENT OF GROUP
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Name | MARK FIGURSKI
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Credential | MD
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Telephone | 800-968-6866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 5101007471
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License Number State | MI
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