NPIMap

Organization Active NPI

Spectrum Health Hospitals

Doing business as Spectrum Health Surgical Center - South Pavilion

  • Ambulatory Surgical Clinic/Center
  • Grand Rapids, MI
National Provider Identifier
1275529562
Registry record updated Dec 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
416822 Issued in MI
Legal business name
SPECTRUM HEALTH HOSPITALS
Doing business as
Spectrum Health Surgical Center - South Pavilion
Practice address
80 68TH St SE
Grand Rapids, MI 49548-6980
Phone
(616) 391-8260
NPI assigned
Sep 22, 2005
Last updated
Dec 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2015

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

Authorized official

Name
Mr. Douglas D Welday
Title
VP Finance
Phone
(616) 391-2525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 416822 MI Primary

Addresses

Primary practice location

80 68TH St SE
Grand Rapids, MI 49548-6980

Mailing address

100 Michigan St NE
MC 406
Grand Rapids, MI 49503-2560
Phone (616) 391-1774

Other identifiers 2

IdentifierTypeStateIssuer
40072OtherMIBLUE CROSS
5170225MedicaidMI

Other names 1

  • Spectrum Health Surgical Center - South Pavilion Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Spectrum Health87 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449100800000",
    "number": "1275529562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 406",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-1774",
            "fax_number": "616-774-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486980",
            "telephone_number": "616-391-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2015-12-03",
        "status": "A",
        "authorized_official_last_name": "WELDAY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "616-391-2525",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": "416822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "40072",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5170225",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spectrum Health Surgical Center - South Pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.