Provider Demographics
NPI:1114929353
Name:GRAND RIVER EMERGENCY MEDICAL GROUP PLC
Entity Type:Organization
Organization Name:GRAND RIVER EMERGENCY MEDICAL GROUP PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF GROUP
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGURSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-968-6866
Mailing Address - Street 1:PO BOX Q
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-4917
Mailing Address - Country:US
Mailing Address - Phone:800-968-6866
Mailing Address - Fax:616-532-7230
Practice Address - Street 1:200 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4502
Practice Address - Country:US
Practice Address - Phone:616-685-6781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007471207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
500D111750OtherBLUE CROSS BLUE SHIELD
010D160910OtherBLUE CROSS BLUE SHIELD
500D111750OtherBLUE CROSS BLUE SHIELD