Provider Demographics
NPI:1336389162
Name:SPECTRUM HEALTH HOSPITAL HEMOPHILIA
Entity Type:Organization
Organization Name:SPECTRUM HEALTH HOSPITAL HEMOPHILIA
Other - Org Name:SHH HEMOPHILIA (& PHARMACY)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KNAUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:RONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-774-7771
Mailing Address - Street 1:PO BOX 2127
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-2127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-1774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM HEALTH HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-06
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301003540333600000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI940D121370OtherBCBS GROUP