Provider Demographics
NPI:1902941057
Name:SPECTRUM HEALTH KELSEY
Entity Type:Organization
Organization Name:SPECTRUM HEALTH KELSEY
Other - Org Name:KELSEY EMERGENCY PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCE CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:OEHRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-225-6907
Mailing Address - Street 1:PO BOX 3567
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-3567
Mailing Address - Country:US
Mailing Address - Phone:616-975-1845
Mailing Address - Fax:616-975-1870
Practice Address - Street 1:418 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850
Practice Address - Country:US
Practice Address - Phone:989-352-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E96010Medicare PIN
MI0N80640Medicare PIN