Organization
MIDWEST EMERGENCY DEPARTMENT SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM W CRUZEN DO (PRESIDENT)
(618) 624-3368
Entity
Organization
Contact information
Practice address
211 S 3RD ST, BELLEVILLE, IL 62220-1915
(618) 234-2120
Mailing address
PO BOX 8882, FORT WORTH, TX 76124-0882
(817) 451-4208
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08232204
BLUE CROSS BLUE SHIELD
IL
01
—
DF2523
RAILROAD MEDICARE
IL
Enumeration date
05/27/2006
Last updated
10/19/2007
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