Provider Demographics
NPI: | 1841238854 |
---|---|
Name: | HEALTHCARE MIDWEST PC |
Entity Type: | Organization |
Organization Name: | HEALTHCARE MIDWEST PC |
Other - Org Name: | |
Other - Org Type: | |
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: | 269-343-7676 |
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 |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-02 |
Last Update Date: | 2009-06-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | Group - Multi-Specialty |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 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 |
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 |