Organization
NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Active
Other names
Spectrum Health Gerber Memorial Family Medicine - Grant
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL J STASIK (PRESIDENT)
(231) 924-1340
Entity
Organization
Contact information
Practice address
230 S MAPLE ST, GRANT, MI 49327-9006
(231) 834-5995
(231) 834-0248
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4383367
—
MI
Enumeration date
03/14/2007
Last updated
06/03/2016
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