MEDICARE: GRAND RAPIDS MEDICAL EDUCATION PARTNERS

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	282N00000X	General Acute Care Hospital	4301096979	MI

General Provider Information

NPI Number	:	1790098846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND RAPIDS MEDICAL EDUCATION PARTNERS

Provider Business Mailing Address
First Line	:	25 MICHIGAN ST NE STE 2200
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MICHIGAN ST NE STE 2200
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2526
Country	:	US
Telephone Number	:	616-391-3245
Fax Number	:

Authorized Official
Title or Position	:	TY COORDINATOR
Name	:	SUSAN GRICE
Credential	:
Telephone Number	:	616-391-3245

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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