Provider Demographics
NPI:1215009022
Name:INTERNAL MEDICINE OUTPATIENT SERVICES, PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OUTPATIENT SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:HUVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-954-2099
Mailing Address - Street 1:2795 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANDRAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-954-2099
Mailing Address - Fax:616-949-5355
Practice Address - Street 1:2795 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:GRANDRAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-954-2099
Practice Address - Fax:616-949-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4341483Medicaid
0N31890Medicare ID - Type Unspecified
MI4341483Medicaid