Provider Demographics
NPI:1922174218
Name:HEALTHY FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:HEALTHY FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPERTO
Authorized Official - Middle Name:DIVINO
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:616-827-2020
Mailing Address - Street 1:2021 44TH ST SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5349
Mailing Address - Country:US
Mailing Address - Phone:616-827-2020
Mailing Address - Fax:
Practice Address - Street 1:2021 44TH ST SE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5349
Practice Address - Country:US
Practice Address - Phone:616-827-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790736643OtherNPI FOR DR. BLANCO
MI1790736643OtherNPI FOR DR. BLANCO