Provider Demographics
NPI:1013166222
Name:MIDWEST INSTITUTE OF HEALTH PC
Entity Type:Organization
Organization Name:MIDWEST INSTITUTE OF HEALTH PC
Other - Org Name:GRAND HEALTH PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-956-6100
Mailing Address - Street 1:2060 E PARIS AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6113
Mailing Address - Country:US
Mailing Address - Phone:616-956-6100
Mailing Address - Fax:616-956-6637
Practice Address - Street 1:2060 E PARIS AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6113
Practice Address - Country:US
Practice Address - Phone:616-956-6100
Practice Address - Fax:616-956-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPK068077208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1256Medicare PIN