Provider Demographics
NPI:1326146283
Name:SPECTRUM HEALTH HOSPITALS
Entity Type:Organization
Organization Name:SPECTRUM HEALTH HOSPITALS
Other - Org Name:SPECTRUM HEALTH URGENT CARE-WEST PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AMBULATORY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHIRCOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-391-2796
Mailing Address - Street 1:80 68TH STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6980
Mailing Address - Country:US
Mailing Address - Phone:616-391-8201
Mailing Address - Fax:616-391-8202
Practice Address - Street 1:6105 WILSON AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418
Practice Address - Country:US
Practice Address - Phone:616-486-5000
Practice Address - Fax:616-486-5101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1236640007OtherDME