CRESTON MEDICAL CENTER, PLLC (NPI# 1154583078) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154583078 |
| Entity Type | Organization |
| Organization Name | CRESTON MEDICAL CENTER, PLLC |
| Other Organization Name | CRESTON MEDICAL CENTER |
| Practice Address |
1330 Plainfield Ave Ne Grand Rapids MI 49505-4913 |
| Mailing Address |
Po Box 2564 Grand Rapids MI 49501-2564 |
| Practice Telephone | 6167761275 |
| Practice Fax Number | 6167763713 |
| Mailing Telephone | 6167761275 |
| Mailing Fax Number | 6167763713 |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2008-07-01 |
| Authorized Official Name | DR. MARGO MARYLAND APP (ADMINISTRATOR) |
| Authorized Official Telephone | 6167760814 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
4301029675 | MI | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Creston Medical Center | Doing Business As Name - Organization |
| Street Address |
1330 PLAINFIELD AVE NE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49505-4913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679783120 | Ruth Jean Vandenberg | Physician Assistant | 1330 Plainfield Ave Ne, Grand Rapids, MI 49505-4913 | 2007-05-23 |
| 1043653082 | Creston Medical Service, PC | Family Medicine | 1330 Plainfield Ave Ne, Grand Rapids, MI 49505-5091 | 2013-04-09 |
| 1225247935 | Peter Beardslee App | Family Medicine | 1330 Plainfield Ave Ne, Grand Rapids, MI 49505-4913 | 2007-05-21 |
| 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 | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
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| 1083760128 | Hackley Hospital | Clinic/Center | 1000 E Paris Ave Se, Ste #260, Grand Rapids, MI 49546-3691 | 2007-01-25 |
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| 1982146098 | John Patrick Basler | Clinic/Center | 1006 19th St, Bay City, MI 48708-7348 | 2016-11-07 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49505 |
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| 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.