GREAT LAKES NEUROSURGICAL ASSOCIATES, PC (NPI# 1306366810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306366810 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES NEUROSURGICAL ASSOCIATES, PC |
| Practice Address |
414 Plymouth Ave Ne Grand Rapids MI 49505-6038 |
| Practice Telephone | (616) 454-3465 |
| Practice Fax Number | 6164549004 |
| Mailing Telephone | 6164543465 |
| Mailing Fax Number | 6164549004 |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | THOMAS MESSINK (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6162427080 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | 0D11057 | 01 |
| MI | 1366590929 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366590929 | Great Lakes Neurosurgical Associates, PC | Neurological Surgery | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2007-01-08 |
| Street Address |
414 PLYMOUTH AVE NE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49505-6038 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225119027 | John E. Stevenson | Neurological Surgery | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2006-10-18 |
| 1932570975 | Neurosurgery Health Services Plc | Physician Assistant | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2015-10-16 |
| 1275791774 | Todd Douglas Vogel | Neurological Surgery | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2008-05-30 |
| 1639359029 | Lynn S Hedeman, Md, PC | Neurological Surgery | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2007-11-14 |
| 1467577817 | Marcia A Fitzgerald | Physician Assistant | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2007-03-21 |
| 1629193487 | Amy Ann Croff | Physician Assistant | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2007-03-20 |
| 1467577239 | Joanna M Polizzi | Physician Assistant | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2007-03-20 |
| 1366590929 | Great Lakes Neurosurgical Associates, PC | Neurological Surgery | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2007-01-08 |
| 1841368685 | Bryan E Figueroa | Neurological Surgery | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2006-12-01 |
| 1245311059 | Joseph R. O'donnell | Neurological Surgery | 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 | 2006-10-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285276097 | Molly Beth Kerkstra | Home Health Aide | 1115 Ball Ave Nw, Grand Rapids, MI 49505 | 2019-10-14 |
| 1154849677 | Roshawn Nichol Whitley | Technician | 891 Maryland Ave, Grand Rapids, MI 49505 | 2017-09-05 |
| 1447778923 | Kelly Benzin-brinks | Social Worker | 1965 3 Mile Rd Ne, Grand Rapids, MI 49505 | 2017-09-05 |
| 1033560404 | Taylor Nolan Boyd | Speech-Language Pathologist | 400 Ann St Ne Ste 106a, Grand Rapids, MI 49505 | 2016-06-28 |
| 1023465002 | Calvin Athy | Counselor | 1101 Ballave Ne, Grand Rapids, MI 49505 | 2016-05-19 |
| 1821456682 | Kelly Van Huisen | Counselor | 1115 Ball Avenue Ne, Building B, Grand Rapids, MI 49505 | 2016-02-08 |
| 1780051102 | Mark Squeteri | Social Worker | 1345 Monroe Ave Nw Ste 234, Grand Rapids, MI 49505 | 2015-09-02 |
| 1346637337 | Shelby Fullington | Social Worker | 1011 Ball Ave Ne, Grand Rapids, MI 49505 | 2015-04-17 |
| 1457745325 | Lester Anderson II | Social Worker | 1115 Ball Ave, Grand Rapids, MI 49505 | 2015-03-27 |
| 1730570151 | Nicole Brown | Counselor | 1345 Monroe Ave Nw Ste 204, Grand Rapids, MI 49505 | 2015-02-06 |
| Find all providers in zip 49505 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689232134 | Supersomnia LLC | Durable Medical Equipment & Medical Supplies | 6886 Cascade Rd Se Ste D, Grand Rapids, MI 49546-6879 | 2019-05-30 |
| 1649723263 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 555 Michigan St Ne Ste 100, Grand Rapids, MI 49503-5753 | 2016-08-01 |
| 1285050435 | Grace Audrey Miller | Durable Medical Equipment & Medical Supplies | 2824 Thornapple River Dr Se, Grand Rapids, MI 49546-6844 | 2014-03-12 |
| 1962830794 | Jerry Burgess Mulder | Durable Medical Equipment & Medical Supplies | 426 Michigan St Ne Ste 207, Grand Rapids, MI 49503-5608 | 2013-10-14 |
| 1447504337 | Integrated Sales and Marketing | Durable Medical Equipment & Medical Supplies | 3721 Pine Park Ct Se, Grand Rapids, MI 49546-9129 | 2012-10-31 |
| 1265705198 | Hanger Prosthetics & Orthotics Inc | Durable Medical Equipment & Medical Supplies | 230 Michigan St Ne Ste 200, Grand Rapids, MI 49503 | 2012-02-23 |
| 1912205030 | Begin Healing, Inc | Durable Medical Equipment & Medical Supplies | 2300 Sw 11th St, Grand Rapids, MN 55744-9777 | 2011-03-14 |
| 1861796112 | Woodward Detroit Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 3590 Plainfield Ave Ne, Grand Rapids, MI 49525-2719 | 2010-12-30 |
| 1811207350 | Spectrum Health Primary Care Partners | Durable Medical Equipment & Medical Supplies | 4085 Burton Se, Suite 102, Grand Rapids, MI 49546 | 2010-10-18 |
| 1184940074 | Hanger Prosthetics & Orthotics Inc | Durable Medical Equipment & Medical Supplies | 5005 Cascade Rd Se Ste C, Grand Rapids, MI 49546-8411 | 2010-04-16 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49505 |
Please comment or provide details below to improve the information on GREAT LAKES NEUROSURGICAL ASSOCIATES, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.