Organization
SOUTHWESTERN MEDICAL CLINIC OC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE BAKER (LAB DIRECTOR)
(269) 473-2387
Entity
Organization
Contact information
Practice address
300 W FERRY ST, BERRIEN SPRINGS, MI 49103-1109
(269) 473-2387
(269) 473-2698
Mailing address
300 W FERRY ST, BERRIEN SPRINGS, MI 49103-1109
(269) 473-2387
(269) 473-2698
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4399652
—
MI
Enumeration date
09/11/2007
Last updated
09/11/2007
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