SOURCE MEDICAL CLINIC
NPI 1326649120
General Practice in Grand Rapids, MI

Q: What is Source Medical Solutions's NPI number?

The NPI number for Source Medical Solutions is 1326649120. It was assigned to this organization in the NPPES registry on November 6, 2020. The provider is also known as Source Medical Clinic.

Q: What is Source Medical Solutions's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Active since November 06, 2020

625 KENMOOR AVE SE STE 301, GRAND RAPIDS, MI 49546(616) 916-8063 Get Directions Write a Review

NPPES record last updated: January 23, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 23, 2022, Nov 25, 2020, Nov 6, 2020 (3 updates tracked since 2020).

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About Source Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOURCE MEDICAL CLINIC (NPI 1326649120) is a healthcare organization registered as a general practice in Grand Rapids, Michigan and active in the NPI registry since November 2020. The organization lists Thomas Henke, Owner/physician, as its authorized official.

NPPES Registry Identity

NPI1326649120

Entity TypeOrganization

Primary Taxonomy208D00000X

Legal Business NameSOURCE MEDICAL SOLUTIONS

Location Address625 KENMOOR AVE SE STE 301Grand Rapids, MI 49546-2395

Mailing Address625 Kenmoor Ave Se Ste 301Grand Rapids, MI 49546-2395 · (616) 916-8063

Phone(616) 916-8063

Organization SubpartNo

Authorized OfficialThomas HenkeOwner/physician · (616) 916-8063

Enumeration DateNovember 6, 2020

Last NPPES UpdateJanuary 23, 20223 updates tracked since enumeration

NPPES CertifiedJanuary 23, 2022

✔ NPI 1326649120 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

625 KENMOOR AVE SE STE 301, Grand Rapids, MI 49546

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Other Names 1

Other NameSource Medical Clinic

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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