The Boutique at Mercy Health Lacks Cancer Center

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

THE BOUTIQUE AT MERCY HEALTH LACKS CANCER CENTER

Doing business as

Trinity Health Boutique

Practice address

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502

Phone

(616) 685-5030

NPI assigned

Aug 5, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Matthew Biersack, MD

Title

President

Phone

(616) 685-6413

Specialties & licenses 1

Addresses

Other names 1

• Trinity Health Boutique Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Saint Mary'S Health Services

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057

  Member Of

  NPD member
• Trinity Health - Michigan

  • Community/Retail Pharmacy
  • Hudsonville, MI
  • NPI 1700351657

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661472000000",
    "number": "1023274446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "616-685-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "616-685-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOUTIQUE AT MERCY HEALTH LACKS CANCER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-05",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A",
        "authorized_official_last_name": "BIERSACK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-685-6413",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Health Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lauren Elizabeth Thayer
• Trystan Robert Thayer, MS, RD
• The Anxiety Clinic LLC
• The Asian Center
• The Blossom Counseling Center for Personal Growth and Development LLC
• The Caregiving Company LLC
• The Change Studio
• The Chiropractic Doctors PLLC
• The Clock Corporation
• The Family Therapy Place PLLC

• Durable Medical Equipment & Medical Supplies in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.