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General NPI Number Information
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NPI Number | 1902111479
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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 | 08/09/2010
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 1140 MONROE AVE NW SUITE 4102
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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 | 616-267-7810
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE MC 845
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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 |
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Fax |
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Authorized Official
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Title or Position | SVP
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Name | PAULINE KRYWANSKI
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Credential |
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Telephone | 616-486-2253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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