Provider Demographics
NPI:1093161820
Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Entity Type:Organization
Organization Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Other - Org Name:SPECTRUM HEALTH LUDINGTON HOSPITAL OBSTETRICS AND GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:STASIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-924-1340
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:
Mailing Address - Fax:
Practice Address - Street 1:250 NELSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1993
Practice Address - Country:US
Practice Address - Phone:231-843-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-11
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health