MEDICARE: SPECTRUM HEALTH PRIMARY CARE PARTNERS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	2086S0102X	Surgical Critical Care Physician
3	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1407140197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HEALTH PRIMARY CARE PARTNERS

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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 N HUDSON ST
Second Line	:
City	:	LOWELL
State	:	MI
Zip	:	49331-1000
Country	:	US
Telephone Number	:	616-897-8436
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT/PAYER REL
Name	:	BRADLEY L SHER
Credential	:
Telephone Number	:	616-486-6705

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	10/27/2023

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