MEDICARE: SPECTRUM HEALTH UNITED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1063781342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HEALTH UNITED

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:	616-486-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 S BALDWIN ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-2102
Country	:	US
Telephone Number	:	616-225-8667
Fax Number	:

Authorized Official
Title or Position	:	VP, PROVIDER SERVICES
Name	:	MR. RYAN K JOHNSON
Credential	:
Telephone Number	:	616-225-6310

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	08/24/2023

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Directions to “SPECTRUM HEALTH UNITED ” Practice Location

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