SPECTRUM HEALTH NPI 1811983000

NPI Information

NPI: 1811983000
Provider Name: SPECTRUM HEALTH

Doing Business As: SPECTRUM HEALTH- LAKE DRIVE SURGERY CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
4069 LAKE DR SE
SUITE 210
GRAND RAPIDS, MI
ZIP 49546
Phone: (616) 285-1120
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SPECTRUM HEALTH is an ambulatory surgical clinic center in Grand Rapids, MI. SPECTRUM HEALTH NPI is 1811983000. The provider is registered as an organization entity type.
The provider Is Doing Business As Spectrum Health- Lake Drive Surgery Center.

The provider's business location address is:

4069 LAKE DR SE
SUITE 210
GRAND RAPIDS, MI
ZIP 49546-816
Phone: (616) 285-1120

The provider's authorized official is Dougals D Welday .
The authorized official title is Vp Finance and has the following contact phone number (616) 391-2525.

The CLIA number assigned to this NPI record is 23D1033113 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/22/2005 and was last updated on 7/29/2014.

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	332B00000X	Durable Medical Equipment & Medical Supplies				No
2	261QA1903X	Clinic/Center	Ambulatory Surgical	416835	MICHIGAN	Yes

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
1	5170255	MEDICAID	MICHIGAN
2	230038	MEDICARE PIN	MICHIGAN
3	41034	OTHER	MICHIGAN	BLUE CROSS

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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