Provider Demographics
NPI:1699042952
Name:SPECTRUM HEALTH HOME MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:SPECTRUM HEALTH HOME MEDICAL EQUIPMENT LLC
Other - Org Name:SPECTRUM HEALTH ORTHOTICS AND PROSTHETICS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP HOME AND COMMUNITY BASED SVCS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-486-3955
Mailing Address - Street 1:1255 MICHIGAN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2001
Mailing Address - Country:US
Mailing Address - Phone:616-486-2950
Mailing Address - Fax:
Practice Address - Street 1:1255 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2001
Practice Address - Country:US
Practice Address - Phone:616-486-2950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies