Organization
VISIONARY MEDICAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN THROOP MD (PRESIDENT)
(616) 988-8220
Entity
Organization
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1680
Mailing address
2536 MOMENTUM PL, CHICAGO, IL 60689-5325
(616) 975-1845
(616) 285-0846
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207P00000X
Emergency Medicine Physician
Primary
—
—
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700D117150
BCBS
MI
01
—
DF8509
RAILROAD MEDICARE
—
Enumeration date
01/04/2007
Last updated
09/20/2023
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