Provider Demographics
NPI:1386633675
Name:ALLENDALE FAMILY PRACTICE
Entity type:Organization
Organization Name:ALLENDALE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-895-2000
Mailing Address - Street 1:11160 WJ PRESLEY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8075
Mailing Address - Country:US
Mailing Address - Phone:616-895-2000
Mailing Address - Fax:616-895-2009
Practice Address - Street 1:11160 WJ PRESLEY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8075
Practice Address - Country:US
Practice Address - Phone:616-895-2000
Practice Address - Fax:616-895-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty