Active NPI
Michigan Medical Patient Care
- Radiology Clinic/Center
- Grand Rapids, MI
National Provider Identifier
1891718813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiology Clinic/Center
- Legal business name
- MICHIGAN MEDICAL PATIENT CARE
- Practice address
- 4100 Lake Dr SE
S-102
Grand Rapids, MI 49546-8292 - Phone
- (616) 974-4800
- NPI assigned
- Jul 25, 2006
- Last updated
- Sep 28, 2010
- Organization subpart
- Yes
- Parent organization
- MICHIGAN MEDICAL PATIENT CARE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Pauline (Polly) Krywanski
- Title
- Cfo
- Phone
- (616) 486-2253
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiology Clinic/Center | 261QR0200X | Primary |
Addresses
Primary practice location
4100 Lake Dr SE
S-102
Grand Rapids, MI 49546-8292
Mailing address
4085 Burton St SE
Suite 200
Grand Rapids, MI 49546-2444
National Provider Directory
National Provider Directory- Part of
- Michigan Medical Patient Care
Locations
4100 Lake Dr SE
#S102
Grand Rapids, MI 49546
Phone (616) 974-4800
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1285632000000",
"number": "1891718813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4085 BURTON ST SE",
"address_2": "SUITE 200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 LAKE DR SE",
"address_2": "S-102",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495468292",
"telephone_number": "616-974-4800"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MICHIGAN MEDICAL PATIENT CARE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MICHIGAN MEDICAL PATIENT CARE",
"enumeration_date": "2006-07-25",
"last_updated": "2010-09-28",
"status": "A",
"authorized_official_last_name": "KRYWANSKI",
"authorized_official_first_name": "PAULINE (POLLY)",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "616-486-2253"
},
"taxonomies": [
{
"code": "261QR0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.