Provider Demographics
NPI:1609769637
Name:GALLOWAY, TAMARIS
Entity type:Individual
Prefix:
First Name:TAMARIS
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 E BELTLINE AVE NE STE 1061409
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7045
Mailing Address - Country:US
Mailing Address - Phone:980-317-0318
Mailing Address - Fax:
Practice Address - Street 1:1971 E BELTLINE AVE NE STE 106-1409
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7045
Practice Address - Country:US
Practice Address - Phone:980-317-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No291U00000XLaboratoriesClinical Medical Laboratory
No171W00000XOther Service ProvidersContractor
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant