MEDICARE: SPRING ARBOR UNIVERSITY

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1821347741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING ARBOR UNIVERSITY

Provider Business Mailing Address
First Line	:	106 EAST MAIN STREET
Second Line	:	C/O SPRING ARBOR UNIVERSITY
City	:	SPRING ARBOR
State	:	MI
Zip	:	49283-9701
Country	:	US
Telephone Number	:	517-750-6352
Fax Number	:	517-750-6625

Provider Business Practice Location Address
First Line	:	106 EAST MAIN STREET
Second Line	:	SPRING ARBOR UNIVERSITY
City	:	SPRING ARBOR
State	:	MI
Zip	:	49283-9701
Country	:	US
Telephone Number	:	517-750-6352
Fax Number	:	517-750-6625

Authorized Official
Title or Position	:	ASSOCIATE V.P. FOR STUDENT DEVELOPM
Name	:	DAN LEE VANDERHILL
Credential	:
Telephone Number	:	517-750-6367

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	05/11/2015

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Directions to “SPRING ARBOR UNIVERSITY ” Practice Location

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