Provider Demographics
NPI:1588615751
Name:INDUSTRIAL MEDICINE OF SOUTHWEST MICHIGAN INC
Entity type:Organization
Organization Name:INDUSTRIAL MEDICINE OF SOUTHWEST MICHIGAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-279-6700
Mailing Address - Street 1:16587 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-7902
Mailing Address - Country:US
Mailing Address - Phone:269-279-6700
Mailing Address - Fax:269-279-9740
Practice Address - Street 1:16587 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-7902
Practice Address - Country:US
Practice Address - Phone:269-279-6700
Practice Address - Fax:269-279-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30727OtherBCBS FACILITY #
MI30727OtherBCBS FACILITY #