Healthcare Provider Details

I. General information

NPI: 1154447035
Provider Name (Legal Business Name): STRATEGIC MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COLUMBUS AVE
BAY CITY MI
48708-6831
US

IV. Provider business mailing address

4100 EMBASSY DRIVE SE SUITE 200
GRAND RAPIDS MI
49546-2416
US

V. Phone/Fax

Practice location:
  • Phone: 989-894-3145
  • Fax: 989-894-6102
Mailing address:
  • Phone: 616-975-1845
  • Fax: 616-285-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301046418
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH WHITESIDE
Title or Position: PRESIDENT
Credential: MD
Phone: 989-894-3145