SOURCE MEDICAL SOLUTIONS NPI 1326649120

NPI Information

NPI: 1326649120
Provider Name: SOURCE MEDICAL SOLUTIONS

Other Name: SOURCE MEDICAL CLINIC

Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
625 KENMOOR AVE SE STE 301
GRAND RAPIDS, MI
ZIP 49546
Phone: (616) 916-8063
Get Directions

SOURCE MEDICAL SOLUTIONS is a general practice in Grand Rapids, MI. SOURCE MEDICAL SOLUTIONS NPI is 1326649120. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Source Medical Clinic.

The provider's business location address is:

625 KENMOOR AVE SE STE 301
GRAND RAPIDS, MI
ZIP 49546-395
Phone: (616) 916-8063

The provider's authorized official is Thomas Henke .
The authorized official title is Owner/physician and has the following contact phone number (616) 916-8063.

The enumeration date for this NPI number is 11/6/2020 and was last updated on 1/23/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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