| Grand Valley Surgical Center, Llc | |
|
2680 Leonard St Ne Ste 1 Grand Rapids MI 49525-6902 | |
| (616) 224-1110 | |
| Not Available |
| Full Name | Grand Valley Surgical Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2680 Leonard St Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Kara Dunwoody (CUSTOMER SERVICES MANAGER) |
| Authorized Official Contact | 6169492410 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Valley Surgical Center, Llc 2680 Leonard St Ne Ste 1 Grand Rapids MI 49525-6902 Ph: (616) 224-1110 | Grand Valley Surgical Center, Llc 2680 Leonard St Ne Ste 1 Grand Rapids MI 49525-6902 Ph: (616) 224-1110 |
| NPI Number | 1417950395 |
|---|---|
| Provider Enumeration Date | 05/24/2005 |
| Last Update Date | 08/16/2012 |
| Medicare PECOS PAC ID | 4183748031 |
|---|---|
| Medicare Enrollment ID | O20100828000193 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417950395 | NPI | - | NPPES |
| OD17003 | Other | MI | BCBS SECONDARY |
| 490004173 | Other | MI | MEDICARE RAILROAD |
| 40362 | Other | MI | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 416829 (Michigan) | Primary |
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