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General NPI Number Information
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NPI Number | 1497065536
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Entity Type | Organization
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Legal Business Name | SPECTRUM HEALTH PRIMARY CARE PARTNERS
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 426 MICHIGAN ST NE SUITE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5609
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Country | US
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Telephone | 616-267-7888
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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 |
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Fax |
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Authorized Official
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Title or Position | SENIOR DIRECTOR REVENUE CYCLE
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Name | LEISA KIMBROUGH
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Credential |
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Telephone | 616-486-6579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology 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 | 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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