Provider Demographics
NPI:1114014594
Name:SPECTRUM HEALTH HOSPITALS
Entity Type:Organization
Organization Name:SPECTRUM HEALTH HOSPITALS
Other - Org Name:COREWELL HEALTH GRAND RAPIDS HOSPITALS DURABLE MEDICAL EQUIP LAKE DR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-391-1663
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 406
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-1774
Mailing Address - Fax:616-391-3052
Practice Address - Street 1:4100 LAKE DRIVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8292
Practice Address - Country:US
Practice Address - Phone:616-391-3759
Practice Address - Fax:616-391-3052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM HEALTH HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1236640001Medicare NSC