Provider Demographics
NPI:1730127663
Name:HEALTHCARE MIDWEST PC
Entity Type:Organization
Organization Name:HEALTHCARE MIDWEST PC
Other - Org Name:HEALTHCARE MIDWEST SUURGERY CENTER
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 1:125 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5239
Mailing Address - Country:US
Mailing Address - Phone:269-343-1381
Mailing Address - Fax:269-343-6321
Practice Address - Street 1:125 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5239
Practice Address - Country:US
Practice Address - Phone:269-343-1381
Practice Address - Fax:269-343-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C97000Medicare ID - Type Unspecified
MIP00100700Medicare PIN