# MEMORIAL MEDICAL CENTER OF WEST MICHIGAN

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1033518634
- **Legal business name:** MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
- **Authorized official:** MARK VIPPERMAN (PRESIDENT)
- **Authorized official phone:** (231) 845-2297

## Contact information

- **Practice address:** 500 N HANCOCK ST, PENTWATER, MI 49449-8935
- **Practice address phone:** (231) 869-7051
- **Mailing address:** 100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
- **Mailing address phone:** (616) 486-6790

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/19/2014
- **Last updated:** 08/21/2014