HEALTHCARE MIDWEST PC

Provider Demographics

• NPI: 1841238854
• Name: HEALTHCARE MIDWEST PC
• Entity type: Organization
• Organization Name: HEALTHCARE MIDWEST PC
• 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 - Phone: 269-343-7676
• Mailing Address - Street 1: 4341 S WESTNEDGE AVE
• Mailing Address - Street 2: SUITE 2205
• Mailing Address - City: KALAMAZOO
• Mailing Address - State: MI
• Mailing Address - Zip Code: 49008-3289
• Mailing Address - Country: US
• Mailing Address - Phone: 269-373-4646
• Mailing Address - Fax: 269-373-7655
• Practice Address - Street 1: 4341 S WESTNEDGE AVE
• Practice Address - Street 2: SUITE 2205
• Practice Address - City: KALAMAZOO
• Practice Address - State: MI
• Practice Address - Zip Code: 49008-3289
• Practice Address - Country: US
• Practice Address - Phone: 269-373-4646
• Practice Address - Fax: 269-373-7655
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-02
• Last Update Date: 2009-06-05

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	207Y00000X	Allopathic & Osteopathic Physicians	Otolaryngology		Group - Multi-Specialty
No	207T00000X	Allopathic & Osteopathic Physicians	Neurological Surgery		Group - Multi-Specialty
No	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	2086S0129X	Allopathic & Osteopathic Physicians	Surgery	Vascular Surgery	Group - Multi-Specialty
No	208800000X	Allopathic & Osteopathic Physicians	Urology		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363LA2200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Adult Health	Group - Multi-Specialty
No	207XS0106X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery	Hand Surgery	Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	207XX0801X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery	Orthopaedic Trauma	Group - Multi-Specialty
No	207XS0117X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery	Orthopaedic Surgery of the Spine	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	0N83170	Medicare PIN
MI	0P07860	Medicare PIN
MI	0N74060	Medicare PIN
MI	0C97000	Medicare PIN
MI	0C97625	Medicare PIN
MI	0P54740	Medicare PIN
MI	0N83160	Medicare PIN
MI	0N11350	Medicare PIN
MI	0N83150	Medicare PIN
MI	0N83140	Medicare PIN