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General NPI Number Information
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NPI Number | 1740510957
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Entity Type | Organization
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Legal Business Name | MED-1 HOLLAND LLC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 383 GARDEN AVE
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City | HOLLAND
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State | MI
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Zip | 49424-9602
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Country | US
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Telephone | 616-494-8271
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 MONROE AVE NW STE 150
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1055
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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 | EXECUTIVE VICE PRESIDENT
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Name | MARY ALICE EHRLICH
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Credential |
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Telephone | 616-459-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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