Provider Demographics
NPI:1568534063
Name:ANESTHESIA ASSOCIATES OF WEST MICHIGAN, PC
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF WEST MICHIGAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREENSLAIT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-845-2348
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-0960
Mailing Address - Country:US
Mailing Address - Phone:231-480-4668
Mailing Address - Fax:231-480-4736
Practice Address - Street 1:1 N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-845-2348
Practice Address - Fax:231-845-3648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI430E31004OtherBLUE CROSS BLUE SHIELD
CE7735OtherRAILROAD MEDICARE
CE7735OtherRAILROAD MEDICARE