Healthcare Provider Details

I. General information

NPI: 1962792929
Provider Name (Legal Business Name): MICHIGAN EM-I MEDICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N MCEWAN ST ER DEPT
CLARE MI
48617-1440
US

IV. Provider business mailing address

815 S PALAFOX ST SUITE 300
PENSACOLA FL
32502-5960
US

V. Phone/Fax

Practice location:
  • Phone: 989-802-5000
  • Fax: 989-802-5120
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS P WEBSTER
Title or Position: OWNER/PRESIDENT
Credential: DO
Phone: 800-230-5160