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General NPI Number Information
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NPI Number | 1861912537
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Entity Type | Organization
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Legal Business Name | SPECTRUM HEALTH PRIMARY CARE PARTNERS
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 9090 S RODGERS CT SE STE A
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City | CALEDONIA
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State | MI
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Zip | 49316-8052
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Country | US
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Telephone | 616-891-0422
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Fax | 616-891-0416
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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 | 616-486-6790
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Fax | 616-486-6702
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Authorized Official
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Title or Position | ASSOCIATE CHIEF MEDICAL OFFICER - R
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Name | DAVID OTTENBAKER
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Credential | MD
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Telephone | 616-486-6686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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