1265513881 NPI number — HEALTHCARE MIDWEST PC

Table of content: (NPI 1265513881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265513881 NPI number — HEALTHCARE MIDWEST PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE MIDWEST PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEALTHCARE MIDWEST HAND SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265513881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 JOHN ST
Provider Second Line Business Mailing Address:
SUITE M-206A
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49007-5341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-349-8601
Provider Business Mailing Address Fax Number:
269-349-6446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
485 COLUMBIA AVE E
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49015-4499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-964-3110
Provider Business Practice Location Address Fax Number:
269-964-3507
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKERNAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
269-373-4646

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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