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General NPI Number Information
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NPI Number | 1497163216
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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 | 07/24/2014
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 500 N HANCOCK ST
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City | PENTWATER
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State | MI
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Zip | 49449-8935
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Country | US
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Telephone | 231-869-7051
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE # MC845
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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 | PRESIDENT
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Name | RANDALL KELLEY
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Credential |
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Telephone | 231-845-2384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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