# SPECTRUM HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SPECTRUM HEALTH SYSTEM
- **Other names:** Spectrum Health- Lake Drive Surgery Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1811983000
- **Legal business name:** SPECTRUM HEALTH SYSTEM
- **Authorized official:** MR. DOUGALS D WELDAY (VP FINANCE)
- **Authorized official phone:** (616) 391-2525

## Contact information

- **Practice address:** 4069 LAKE DR SE, SUITE 210, GRAND RAPIDS, MI 49546-8816
- **Practice address phone:** (616) 285-1120
- **Mailing address:** 100 MICHIGAN ST NE, MC 406, GRAND RAPIDS, MI 49503-2560
- **Mailing address phone:** (616) 391-1774
- **Mailing address fax:** (616) 774-7699

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 416835 | MI | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 09/22/2005
- **Last updated:** 07/29/2014