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NPI Code Detail

MEDICARE: MIDWEST EMERGENCY CENTRALIA CAMPUS ASSOCIATES, INC

MEDICARE: MIDWEST EMERGENCY CENTRALIA CAMPUS ASSOCIATES, INC
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
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1396034245
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWEST EMERGENCY CENTRALIA CAMPUS ASSOCIATES, INC
Provider Business Mailing Address
First Line : 6451 BRENTWOOD STAIR ROAD
Second Line : SUITE 202
City : FORT WORTH
State : TX
Zip : 76112-3200
Country : US
Telephone Number : 817-451-4208
Fax Number : 817-563-3699
Provider Business Practice Location Address
First Line : 400 NORTH PLEASANT AVENUE
Second Line :
City : CENTRALIA
State : IL
Zip : 62801-3056
Country : US
Telephone Number : 817-451-4208
Fax Number : 817-563-3699
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM W CRUZEN
Credential : DO
Telephone Number : 817-451-4208
Provider Enumeration Date : 03/31/2011
Last Update Date : 10/30/2012

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Directions to “MIDWEST EMERGENCY CENTRALIA CAMPUS ASSOCIATES, INC ” Practice Location

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