Provider Demographics
NPI:1477846327
Name:SPECTRUM HEALTH KELSEY
Entity Type:Organization
Organization Name:SPECTRUM HEALTH KELSEY
Other - Org Name:SPECTRUM HEALTH KELSEY NURSE PRACTITIONERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:OEHRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-225-6426
Mailing Address - Street 1:418 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850-9806
Mailing Address - Country:US
Mailing Address - Phone:989-352-7211
Mailing Address - Fax:
Practice Address - Street 1:418 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-9806
Practice Address - Country:US
Practice Address - Phone:989-352-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E96010Medicare PIN