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General NPI Number Information
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NPI Number | 1508055294
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Entity Type | Organization
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Legal Business Name | ADVANTAGE HEALTH CONVENIENT CARE PLLC
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 6370 LAKE MICHIGAN DR STE 100
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City | ALLENDALE
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State | MI
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Zip | 49401-9226
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Country | US
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Telephone | 616-895-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 245 STATE ST SE STE 326
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4328
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Country | US
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Telephone | 616-913-1800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CMO
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Name | DAVID E BLAIR
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Credential |
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Telephone | 616-913-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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