Provider Demographics
NPI:1386971711
Name:PHYSICIAN'S HOME NETWORK, PLLC
Entity type:Organization
Organization Name:PHYSICIAN'S HOME NETWORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITKO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:616-608-7403
Mailing Address - Street 1:3033 ORCHARD VISTA DR SE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7077
Mailing Address - Country:US
Mailing Address - Phone:616-608-7403
Mailing Address - Fax:616-608-7408
Practice Address - Street 1:3033 ORCHARD VISTA DR SE
Practice Address - Street 2:SUITE 309
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7077
Practice Address - Country:US
Practice Address - Phone:616-608-7403
Practice Address - Fax:616-608-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty