Organization
EASTERN CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARYL SMITH (PROGRAM DIRECTOR)
(616) 243-6262
Entity
Organization
Contact information
Practice address
1555 EASTERN AVE SE, GRAND RAPIDS, MI 49507-2055
(616) 243-6262
(616) 243-6969
Mailing address
1555 EASTERN AVE SE, GRAND RAPIDS, MI 49507-2055
(616) 243-6262
(616) 243-6969
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
SA0410165
MI
Other
Enumeration date
12/09/2015
Last updated
12/09/2015
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