Healthcare Provider Details

I. General information

NPI: 1609963503
Provider Name (Legal Business Name): SOUTHWEST MICHIGAN CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 RED ARROW HWY
COLOMA MI
49038-9703
US

IV. Provider business mailing address

6720 RED ARROW HWY
COLOMA MI
49038-9703
US

V. Phone/Fax

Practice location:
  • Phone: 269-468-6760
  • Fax:
Mailing address:
  • Phone: 269-468-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH J EDWARDS
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 269-428-3500