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	133NN1002X	Nutrition Education Nutritionist
2	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1417385170
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 S GREENVILLE WEST DR
Second Line	:	STE. 1
City	:	GREENVILLE
State	:	MI
Zip	:	48838-3516
Country	:	US
Telephone Number	:	616-754-6185
Fax Number	:

Authorized Official
Title or Position	:	SVP FINANCE
Name	:	PAULINE KRYWANSKI
Credential	:
Telephone Number	:	616-486-2253

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	10/16/2013

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Directions to “SPECTRUM HEALTH UNITED ” Practice Location

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