Provider Demographics
NPI:1629465653
Name:PLANNED PARENTHOOD OF WEST AND NORTHERN MICHIGAN
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF WEST AND NORTHERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:616-774-7005
Mailing Address - Street 1:425 CHERRY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4601
Mailing Address - Country:US
Mailing Address - Phone:616-774-7005
Mailing Address - Fax:616-774-0516
Practice Address - Street 1:425 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4601
Practice Address - Country:US
Practice Address - Phone:616-774-7005
Practice Address - Fax:616-774-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1174610406OtherFAMILY PLANNING