Provider Demographics
NPI:1841480134
Name:PSYCHIATRIC ASSOCIATES OF WEST MICHIGAN, PLC
Entity type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF WEST MICHIGAN, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-735-1505
Mailing Address - Street 1:PO BOX 140241
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49514-0241
Mailing Address - Country:US
Mailing Address - Phone:616-735-1505
Mailing Address - Fax:616-675-1153
Practice Address - Street 1:6555 HERON BAY DR
Practice Address - Street 2:
Practice Address - City:SAUGATUCK
Practice Address - State:MI
Practice Address - Zip Code:49453-9687
Practice Address - Country:US
Practice Address - Phone:616-719-4488
Practice Address - Fax:616-719-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M42950Medicare PIN