Provider Demographics
NPI:1629684386
Name:TRUE WOMEN'S CLINIC OF GRAND RAPIDS, PC
Entity Type:Organization
Organization Name:TRUE WOMEN'S CLINIC OF GRAND RAPIDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-330-1700
Mailing Address - Street 1:2144 E PARIS AVE SE STE 230
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6111
Mailing Address - Country:US
Mailing Address - Phone:616-330-1700
Mailing Address - Fax:616-330-1709
Practice Address - Street 1:2144 E PARIS AVE SE STE 230
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6111
Practice Address - Country:US
Practice Address - Phone:616-330-1700
Practice Address - Fax:616-330-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty