Provider Demographics
NPI:1518166842
Name:HEALTHCARE MIDWEST PC
Entity Type:Organization
Organization Name:HEALTHCARE MIDWEST PC
Other - Org Name:PULMONARY & SLEEP MEDICINE A DIVISION OF HEALTHCARE MIDWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-373-4646
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M401
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-388-5864
Mailing Address - Fax:269-388-5211
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M401
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-388-5864
Practice Address - Fax:269-388-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI290C913410OtherBCBSM GROUP PIN