Provider Demographics
NPI:1467470492
Name:WESTERN MICHIGAN UNIVERSITY
Entity Type:Organization
Organization Name:WESTERN MICHIGAN UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:269-387-3280
Mailing Address - Street 1:1903 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5200
Mailing Address - Country:US
Mailing Address - Phone:269-387-4303
Mailing Address - Fax:269-387-2944
Practice Address - Street 1:1903 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5200
Practice Address - Country:US
Practice Address - Phone:269-387-4303
Practice Address - Fax:269-387-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540C943500OtherBLUE CROSS DME
MI650C900880OtherBCBS LABORATORY
MI650C912390OtherBLUE CROSS PT-BRENDA
MI650C912530OtherBLUE CROSS PT-DAREN
MI650C912400OtherBLUE CROSS PT-RAINER
MI680C900600OtherBLUE CROSS PSYCHOLOGIST
MI480C900500OtherBLUE CROSS PODIATRY
MI700C947350OtherBLUE CROSS BLUE SHIELD
MI700C947350OtherBLUE CROSS BLUE SHIELD
MI680C900600OtherBLUE CROSS PSYCHOLOGIST
MI0P06360Medicare PIN