Provider Demographics
NPI:1497706840
Name:METRO HEALTH BASIC CARE
Entity Type:Organization
Organization Name:METRO HEALTH BASIC CARE
Other - Org Name:METRO ADVANTAGE INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-252-7200
Mailing Address - Street 1:1925 BRETON RD SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4810
Mailing Address - Country:US
Mailing Address - Phone:616-252-4765
Mailing Address - Fax:616-252-0127
Practice Address - Street 1:5500 CLYDE PARK AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9525
Practice Address - Country:US
Practice Address - Phone:616-531-7769
Practice Address - Fax:616-531-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP34900Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER