Healthcare Provider Details
I. General information
NPI: 1992281000
Provider Name (Legal Business Name): ECS WESTERN MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/12/2018
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
100 MICHIGAN ST NE
GRAND RAPIDS MI
49503
US
IV. Provider business mailing address
PO BOX 22067
LANSING MI
48909-2067
US
V. Phone/Fax
- Phone: 616-391-1730
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
JOHN
THROOP
Title or Position: PRESIDENT
Credential: MD
Phone: 616-988-8220