Provider Demographics
NPI:1487626271
Name:WEST MICHIGAN CARDIOTHORACIC SURGEONS PLC
Entity Type:Organization
Organization Name:WEST MICHIGAN CARDIOTHORACIC SURGEONS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:616-459-7258
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 103
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-459-7258
Mailing Address - Fax:616-459-5215
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:SUITE 8830
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-459-7258
Practice Address - Fax:616-459-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
330D16173OtherBCBSM
MI0D16173Medicare ID - Type Unspecified
MI0N54220Medicare ID - Type Unspecified