MEDICARE: HOSPICE CARE OF SOUTHWEST MICHIGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	393510	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08710	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235197401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE CARE OF SOUTHWEST MICHIGAN

Provider Business Mailing Address
First Line	:	222 N KALAMAZOO MALL
Second Line	:	SUITE 100
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-3882
Country	:	US
Telephone Number	:	269-345-0273
Fax Number	:	269-345-8522

Provider Business Practice Location Address
First Line	:	222 N KALAMAZOO MALL
Second Line	:	SUITE 100
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-3881
Country	:	US
Telephone Number	:	269-345-0273
Fax Number	:	269-345-8522

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	KELLY MCCORMICK
Credential	:
Telephone Number	:	269-345-0273

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/17/2019

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Directions to “HOSPICE CARE OF SOUTHWEST MICHIGAN ” Practice Location

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