SPECTRUM HEALTH SURGICAL CENTER - SOUTH PAVILION
NPI 1275529562
Clinic/Center - Ambulatory Surgical in Grand Rapids, MI
- Organization
- Clinic/Center
- Ambulatory Surgical
- CLIA Number: 23D0958096
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 11-12-2026
About SPECTRUM HEALTH SURGICAL CENTER - SOUTH PAVILION
This page provides the complete NPI Profile along with additional information for Spectrum Health Surgical Center - South Pavilion, a provider established in Grand Rapids, Michigan operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1275529562 assigned on September 2005. The practitioner's primary taxonomy code is 261QA1903X with license number 416822 (MI). The provider is registered as an organization and their NPI record was last updated 11 years ago. The provider's is doing business as Spectrum Health Surgical Center - South Pavilion. The authorized official of this NPI record is Mr. Douglas D Welday (Vp Finance)
- NPI
- 1275529562 Verify this NPI
- Provider Legal Name
- SPECTRUM HEALTH HOSPITALS
- Other Organization Name
- SPECTRUM HEALTH SURGICAL CENTER - SOUTH PAVILION
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 80 68TH ST SE GRAND RAPIDS, MI 49548
- Location Phone
- (616) 391-8260
- Mailing Address
- 100 MICHIGAN ST NE MC 406 GRAND RAPIDS, MI 49503
- Mailing Phone
- (616) 391-1774
- Mailing Fax
- (616) 774-7699
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-22-2005
- Last Update Date
- 12-03-2015
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
- License No.
- 416822
- License State
- MI
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 5170225 | MEDICAID (05) | MI | |
| 230038 | MEDICARE PIN (08) | MI | |
| 40072 | OTHER (01) | MI | BLUE CROSS |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 23D0958096
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- November 13, 2024
- Certificate Expiration Date
- November 12, 2026
- Laboratory Director
- KENDALL D. HAMILTON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Spectrum Health Surgical Center - South Pavilion to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
GRAND RAPIDS, MI 49548
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1275529562, enumerated as an "organization" on September 22, 2005.
The provider is located at 80 68TH ST SE GRAND RAPIDS, MI 49548 and the phone number is (616) 391-8260.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
The provider might be accepting Accepts: Medicare, Medicaid and Blue Cross Blue Shield. Please consult your insurance carrier or call the provider to verify.
