Provider Demographics
NPI:1043598923
Name:GRAND RAPIDS MEDICAL EDUCATION PARTNERS
Entity Type:Organization
Organization Name:GRAND RAPIDS MEDICAL EDUCATION PARTNERS
Other - Org Name:GRAND RAPIDS MEDICAL EDUCATION AND RESEARCH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOOLSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-391-3775
Mailing Address - Street 1:510 COLLEGE AVE NE APT 213
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1770
Mailing Address - Country:US
Mailing Address - Phone:616-710-9370
Mailing Address - Fax:
Practice Address - Street 1:200 JEFFERSON STREET SE
Practice Address - Street 2:SAINT MARY'S HEALTH CARE
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1770
Practice Address - Country:US
Practice Address - Phone:616-710-9370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital