Provider Demographics
NPI:1508030479
Name:SPECTRUM HEALTH CONTINUING CARE
Entity Type:Organization
Organization Name:SPECTRUM HEALTH CONTINUING CARE
Other - Org Name:SPECTRUM HEALTH INFUSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, COMM. & HOME BASED SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZICKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
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:616-486-3950
Mailing Address - Fax:616-486-3940
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:616-486-3950
Practice Address - Fax:616-486-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010088493336H0001X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2371045OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6183390001Medicare NSC