Provider Demographics
NPI:1679510572
Name:SOUTHWEST MI RADIOLOGY PLLC
Entity Type:Organization
Organization Name:SOUTHWEST MI RADIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARTGERINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-857-8437
Mailing Address - Street 1:327 WATER ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1325
Mailing Address - Country:US
Mailing Address - Phone:269-686-9845
Mailing Address - Fax:269-686-1355
Practice Address - Street 1:555 LINN ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1524
Practice Address - Country:US
Practice Address - Phone:269-686-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53150134832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N23810Medicare ID - Type UnspecifiedPHYSICIAN GROUP NUMBER