Basic Information
| Provider Information | |||||||||
| NPI: | 1063572568 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BORGESS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5943 STADIUM DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490093016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695522836 | ||||||||
| FaxNumber: | 2695522835 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 NAOMI ST | ||||||||
| Address2: | |||||||||
| City: | PLAINWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490801257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695520100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MILLERMAIER | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2695522910 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.