Provider Demographics
NPI:1861800674
Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Entity type:Organization
Organization Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-802-0206
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2481 N 72ND AVE
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-8008
Practice Address - Country:US
Practice Address - Phone:231-873-2163
Practice Address - Fax:231-873-2143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-24
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care