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General NPI Number Information
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NPI Number | 1144639360
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Entity Type | Organization
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Legal Business Name | MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 5 N ATKINSON DR
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City | LUDINGTON
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State | MI
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Zip | 49431-2918
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Country | US
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Telephone | 231-845-3615
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE MC 845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone | 616-486-6790
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Fax |
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Authorized Official
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Title or Position | VP, PROVIDER SERVICES
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Name | RYAN CATIGNANI
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Credential |
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Telephone | 947-522-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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