RANDALL STREET MEDICAL PC NPI 1598734584

NPI Information

  • NPI: 1598734584
  • Provider Name: RANDALL STREET MEDICAL PC
  • Classification: Clinic/Center - 261QR1300X
  • Specialization: Rural Health
  • Entity Type: Organization
  • CLIA Number: 23D0379159
  • Address: 675 W RANDALL ST
    COOPERSVILLE, MI
    ZIP 49404
  • Phone: (616) 837-9777

Map and Directions

Get Directions

NPI Details

RANDALL STREET MEDICAL PC is a rural health clinic center in Coopersville, MI. RANDALL STREET MEDICAL PC NPI is 1598734584. The provider is registered as an organization entity type.

The provider's business location address is:

675 W RANDALL ST
COOPERSVILLE, MI
ZIP 49404-305
Phone: (616) 837-9777
Fax: (616) 837-7813

The provider's authorized official is Roger Holman .
The authorized official title is Owner/physician and has the following contact phone number (616) 837-9777.

The CLIA number assigned to this NPI record is 23D0379159 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 3/14/2006 and was last updated on 7/22/2008.

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
1261QR1300XClinic/CenterRural Health5101006733MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1005703574OTHERMICHIGANBCBSMI
2S79627MEDICARE UPINMICHIGAN
3P57675OTHERMICHIGANBLUES HMO'S
4E26596MEDICARE UPINMICHIGAN
5233956MEDICARE OSCAR/CERTIFICATIONMICHIGAN
60027003OTHERMICHIGANPRIORITY HEALTH HMO
74313667MEDICAIDMICHIGAN

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: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI