Organization
SPECTRUM HEALTH HOSPITALS
Active
Other names
Spectrum Health Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS D. WELDAY (VICE PRESIDENT OF FINANCE)
(616) 391-2525
Entity
Organization
Contact information
Practice address
4100 LAKE DR SE, GRAND RAPIDS, MI 49546-8292
(616) 391-7580
Mailing address
100 MICHIGAN ST NE, MC 406, GRAND RAPIDS, MI 49503-2560
(616) 391-1774
(616) 774-7699
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
416830
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40124
BLUE CROSS
MI
05
—
5170255
—
MI
Enumeration date
09/22/2005
Last updated
10/21/2014
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