Provider Demographics
NPI:1982908323
Name:ROBERT W VAN NOORD PC
Entity Type:Organization
Organization Name:ROBERT W VAN NOORD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VAN NOORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-956-6700
Mailing Address - Street 1:4133 EMBASSY DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2418
Mailing Address - Country:US
Mailing Address - Phone:616-956-6700
Mailing Address - Fax:616-956-6773
Practice Address - Street 1:4133 EMBASSY DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2418
Practice Address - Country:US
Practice Address - Phone:616-956-6700
Practice Address - Fax:616-956-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001896261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD14556OtherBLUE CROSS BLUE SHIELD PIN
MI6301001896OtherFPSYCHOLOGIST LICENSE #
MIOD14556Medicare PIN