Organization
MIDWEST EMERGENCY 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
6800 STATE ROUTE 162, MARYVILLE, IL 62062-8500
(618) 288-5711
Mailing address
PO BOX 8351, FORT WORTH, TX 76124-0351
(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
—
06032182
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/26/2006
Last updated
06/04/2008
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