Organization Name: | RICHARD J LACKS CANCER CENTER |
NPI Number: | 1023274446 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIFER VIDEAN (PROVIDER ENROLLMENT SPECIALIST) |
Mailing Address: | 200 Jefferson Ave Se Grand Rapids |
State: | MI US |
Postal Code: | 495034502 |
Phone Number: | 8009686866 |
Fax Number: | |
NPI Enumeration Date: | 08/05/2008 |
NPI Last Update Date: | 05/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |