Organization
BRONSON VICKSBURG HOSPITAL, INC.
Active
Parent organization
BRONSON VICKSBURG HOSPITAL
Other names
Bronson Vicksburg Emergency Physicians
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRONSON VICKSBURG HOSPITAL
Authorized official
MS. DENISE M BARTZ (CONTRACT CREDENTIALING COORDINATOR)
(269) 341-7806
Entity
Organization
Contact information
Practice address
13326 N BOULEVARD ST, VICKSBURG, MI 49097-1514
(269) 649-2321
Mailing address
601 JOHN ST, BOX 42, KALAMAZOO, MI 49007-5341
(269) 341-7806
(269) 341-8743
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C96065
BCBSM
MI
01
—
C20578
RAILROAD MEDICARE
MI
Enumeration date
07/28/2006
Last updated
12/15/2010
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