NPIMap

Organization Active NPI

Eastern Clinic PLLC

  • Methadone Clinic
  • Grand Rapids, MI
National Provider Identifier
1942675426
Registry record updated Dec 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
SA0410165 Issued in MI
Legal business name
EASTERN CLINIC PLLC
Practice address
1555 Eastern Ave SE
Grand Rapids, MI 49507-2055
Phone
(616) 243-6262
Fax
(616) 243-6969
NPI assigned
Dec 9, 2015
Last updated
Dec 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2015

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

Authorized official

Name
Mr. Daryl Smith
Title
Program Director
Phone
(616) 243-6262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X SA0410165 MI Primary

Addresses

Primary practice location

1555 Eastern Ave SE
Grand Rapids, MI 49507-2055

Mailing address

1555 Eastern Ave SE
Grand Rapids, MI 49507-2055
Phone (616) 243-6262

National Provider Directory

National Provider Directory
Tax ID family
Eastern Clinic PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1555 Eastern Ave SE
Grand Rapids, MI 49507
Phone (616) 243-6262

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449619200000",
    "number": "1942675426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 EASTERN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495072055",
            "telephone_number": "616-243-6262",
            "fax_number": "616-243-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 EASTERN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495072055",
            "telephone_number": "616-243-6262",
            "fax_number": "616-243-6969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-09",
        "last_updated": "2015-12-09",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DARYL",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "616-243-6262",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MI",
            "license": "SA0410165",
            "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 Dec 9, 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.