Organization
SOUTH COUNTY ENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY GEEGAN MIDDLETON (EXECUTIVE DIRECTOR)
(269) 684-0259
Entity
Organization
Contact information
Practice address
60 N SAINT JOSEPH AVE, SUITE C, NILES, MI 49120-2296
(269) 687-2910
(269) 687-8770
Mailing address
60 N SAINT JOSEPH AVE, SUITE C, NILES, MI 49120-2296
(269) 687-2910
(269) 687-8770
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301074195
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA1319
RAILROAD MEDICARE
—
Enumeration date
02/06/2006
Last updated
11/01/2007
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