Organization
SPECTRUM HEALTH HOSPITALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELISABETH LACEY (MANAGER, ENROLLMENT SERVICES)
(616) 486-6630
Entity
Organization
Contact information
Practice address
4069 LAKE DR SE STE 210, GRAND RAPIDS, MI 49546-8816
(616) 285-1120
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1030000014
STATE OF MI
MI
01
—
1030000022
STATE OF MI
MI
Enumeration date
02/22/2019
Last updated
02/22/2019
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