Organization
WESTERN MICHIGAN UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL EDDY MPA (DIRECTOR)
(269) 387-3280
Entity
Organization
Contact information
Practice address
1903 W MICHIGAN AVE, KALAMAZOO, MI 49008-5200
(269) 387-4303
(269) 387-2944
Mailing address
1903 W MICHIGAN AVE, KALAMAZOO, MI 49008-5200
(269) 387-4303
(269) 387-2944
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480C900500
BLUE CROSS PODIATRY
MI
01
—
540C943500
BLUE CROSS DME
MI
01
—
650C900880
BCBS LABORATORY
MI
01
—
650C912390
BLUE CROSS PT-BRENDA
MI
01
—
650C912400
BLUE CROSS PT-RAINER
MI
01
—
650C912530
BLUE CROSS PT-DAREN
MI
01
—
680C900600
BLUE CROSS PSYCHOLOGIST
MI
01
—
700C947350
BLUE CROSS BLUE SHIELD
MI
Enumeration date
07/17/2006
Last updated
01/11/2012
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