=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528880705
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTLAND PRIMARY CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2024
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 E CASS ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48838-1905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-221-4302
-----------------------------------------------------
Fax | 616-232-2034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 123 E CASS ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48838-1905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-221-4302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | CATHERINE GRIMM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-221-4302
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------