Provider Demographics
NPI:1811585185
Name:ADVANTAGE HEALTH SAINT MARY'S MEDICAL GROUP
Entity Type:Organization
Organization Name:ADVANTAGE HEALTH SAINT MARY'S MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-685-1802
Mailing Address - Street 1:730 GRANDVILLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4920
Mailing Address - Country:US
Mailing Address - Phone:616-685-8400
Mailing Address - Fax:616-742-1322
Practice Address - Street 1:730 GRANDVILLE AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4920
Practice Address - Country:US
Practice Address - Phone:616-685-8400
Practice Address - Fax:616-742-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty