Provider Demographics
NPI:1669779005
Name:SPECTRUM HEALTH PRIMARY CARE PARTNERS
Entity type:Organization
Organization Name:SPECTRUM HEALTH PRIMARY CARE PARTNERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRYWANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-486-2253
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6795
Mailing Address - Fax:616-486-6675
Practice Address - Street 1:100 PINE ST
Practice Address - Street 2:SUITE 225
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-2600
Practice Address - Country:US
Practice Address - Phone:616-748-6048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM HEALTH PRIMARY CARE PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-22
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty