| Grand Medical Associates | |
|
1676 Viewpond Drive Se Suite 100a Kentwood MI 49508 | |
| (616) 455-9450 | |
| (616) 455-5221 |
| Full Name | Grand Medical Associates |
|---|---|
| Speciality | Internal Medicine |
| Location | 1676 Viewpond Drive Se, Kentwood, Michigan |
| Authorized Official Name and Position | John Nelson Campbell (PRESIDENT) |
| Authorized Official Contact | 6164559450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Medical Associates 1676 Viewpond Drive Se Suite 100a Kentwood MI 49508 Ph: (616) 455-9450 | Grand Medical Associates 1676 Viewpond Drive Se Suite 100a Kentwood MI 49508 Ph: (616) 455-9450 |
| NPI Number | 1598853608 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 11/01/2022 |
| Medicare PECOS PAC ID | 9335155316 |
|---|---|
| Medicare Enrollment ID | O20060228000650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598853608 | NPI | - | NPPES |
| 1076881 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 034105 (Michigan) | Primary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Secondary |
| Provider Name | John N Campbell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417901232 PECOS PAC ID: 5395729651 Enrollment ID: I20040615000574 |
| Provider Name | Monica A Lyons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205989704 PECOS PAC ID: 0840474334 Enrollment ID: I20110407000284 |
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