Provider Demographics
NPI:1396301719
Name:GRAND RIVER FAMILY CARE, PC
Entity type:Organization
Organization Name:GRAND RIVER FAMILY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-339-2116
Mailing Address - Street 1:1881 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1840
Mailing Address - Country:US
Mailing Address - Phone:517-339-2116
Mailing Address - Fax:517-339-4620
Practice Address - Street 1:1881 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1840
Practice Address - Country:US
Practice Address - Phone:517-339-2116
Practice Address - Fax:517-339-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty