Provider Demographics
NPI:1710993357
Name:BRONSON METHODIST HOSPITAL
Entity Type:Organization
Organization Name:BRONSON METHODIST HOSPITAL
Other - Org Name:BRONSON HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP LEGAL AFFAIRS, C
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:FALAHEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:269-341-6000
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7806
Mailing Address - Fax:269-341-8143
Practice Address - Street 1:6938 ELM VALLEY DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-7447
Practice Address - Country:US
Practice Address - Phone:269-341-7272
Practice Address - Fax:269-341-6867
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRONSON METHODIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-01
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390020251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI72-30018OtherUNITED HEALTHCARE
MIOE121OtherBCBSM
MI5246442Medicaid
MI3209753Medicaid
MI237288Medicare PIN
MIOE121OtherBCBSM
MI237288Medicare Oscar/Certification