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General NPI Number Information
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NPI Number | 1841233574
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Entity Type | Organization
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Legal Business Name | SAINT MARYS HOME INFUSION PROGRAM
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 360 DIVISION AVE S STE #1D
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4501
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Country | US
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Telephone | 616-685-1111
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Fax | 616-685-1122
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Provider Business Mailing Address
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Address Line | 360 DIVISION AVE SOUTH STE 1D
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-685-1111
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Fax | 616-685-1122
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Authorized Official
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Title or Position | REGIONAL CFO AND TREASURER
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Name | MICHAEL PAUL GUSHO
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Credential |
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Telephone | 231-672-3886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301007544
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License Number State | MI
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