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Organization
LAKESHORE AREA RADIATION ONCOLOGY CENTER
Active
Organization
LAKESHORE AREA RADIATION ONCOLOGY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN POWERS (EXECUTIVE DIRECTOR)
(616) 772-7513
Entity
Organization
Contact information
Practice address
12642 RILEY ST, HOLLAND, MI 49424-9202
(616) 355-3876
(616) 786-0255
Mailing address
12642 RILEY ST, HOLLAND, MI 49424-9202
(616) 355-3876
(616) 786-0255
Taxonomy
Speciality
Code
Description
License number
State
261QX0203X
Radiation Oncology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002827
PRIORITY HEALTH
MI
01
—
32-0-G0-1091-0
BCBSM
MI
Enumeration date
10/04/2006
Last updated
06/15/2015
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