| Corewell Health Grand Rapids Hospitals Pediatric Dialysis | |
|
35 Michigan St Ne Grand Rapids MI 49503-2514 | |
| (616) 391-9000 | |
| Not Available |
| Full Name | Corewell Health Grand Rapids Hospitals Pediatric Dialysis |
|---|---|
| Speciality | Clinic/Center |
| Location | 35 Michigan St Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Matthew E Cox (VICE PRESIDENT OF FINANCE) |
| Authorized Official Contact | 6163911663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corewell Health Grand Rapids Hospitals Pediatric Dialysis 100 Michigan St Ne Mc 406 Grand Rapids MI 49503-2560 Ph: (616) 391-1774 | Corewell Health Grand Rapids Hospitals Pediatric Dialysis 35 Michigan St Ne Grand Rapids MI 49503-2514 Ph: (616) 391-9000 |
| NPI Number | 1962494120 |
|---|---|
| Provider Enumeration Date | 08/15/2005 |
| Last Update Date | 10/16/2023 |
| Medicare PECOS PAC ID | 8921904764 |
|---|---|
| Medicare Enrollment ID | O20031211000325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962494120 | NPI | - | NPPES |
| 4695800 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 410040 (Michigan) | Secondary |
| 261QE0700X | Clinic/center - End-stage Renal Disease (esrd) Treatment | 410040 (Michigan) | Primary |
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