Provider Demographics
NPI:1033518634
Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Entity Type:Organization
Organization Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VIPPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-845-2297
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:500 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PENTWATER
Practice Address - State:MI
Practice Address - Zip Code:49449-8935
Practice Address - Country:US
Practice Address - Phone:231-869-7051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-19
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty