Provider Demographics
NPI:1033396023
Name:SOUTHWESTERN MICHIGAN EMERGENCY SERVICES, PC
Entity Type:Organization
Organization Name:SOUTHWESTERN MICHIGAN EMERGENCY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-343-3900
Mailing Address - Street 1:8993 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:866-898-7139
Mailing Address - Fax:
Practice Address - Street 1:408 HAZEN ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1019
Practice Address - Country:US
Practice Address - Phone:269-343-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty