Provider Demographics
NPI:1275529562
Name:SPECTRUM HEALTH HOSPITALS
Entity Type:Organization
Organization Name:SPECTRUM HEALTH HOSPITALS
Other - Org Name:SPECTRUM HEALTH SURGICAL CENTER - SOUTH PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-391-2525
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:616-774-7699
Practice Address - Street 1:80 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6980
Practice Address - Country:US
Practice Address - Phone:616-391-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI416822261QA1903X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40072OtherBLUE CROSS
MI5170225Medicaid
MI230038Medicare PIN
230038Medicare ID - Type Unspecified