NPIMap

Organization Active NPI

Spectrum Health Hospitals

  • Ambulatory Surgical Clinic/Center
  • Grand Rapids, MI
National Provider Identifier
1366438632
Registry record updated Oct 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
416830 Issued in MI
Legal business name
SPECTRUM HEALTH HOSPITALS
Practice address
4100 Lake Dr SE
Grand Rapids, MI 49546-8292
Phone
(616) 391-7580
NPI assigned
Sep 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2014

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

Authorized official

Name
Mr. Douglas D. Welday
Title
Vice President of Finance
Phone
(616) 391-2525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 416830 MI Primary

Addresses

Primary practice location

4100 Lake Dr SE
Grand Rapids, MI 49546-8292

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
5170255MedicaidMI
40124OtherMIBLUE CROSS

Other names 1

  • Spectrum Health Endoscopy Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grand Rapids Pediatrics86 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

Locations

4100 Lake Dr SE
Ste 105
Grand Rapids, MI 49546
Phone (616) 391-7580

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": "1413849600000",
    "number": "1366438632",
    "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": "4100 LAKE DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468292",
            "telephone_number": "616-391-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2014-10-21",
        "status": "A",
        "authorized_official_last_name": "WELDAY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "VICE PRESIDENT OF 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": "416830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5170255",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "40124",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spectrum Health Endoscopy Center",
            "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 Oct 21, 2014; 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.