Healthcare Provider Details

I. General information

NPI: 1407886377
Provider Name (Legal Business Name): WESTSIDE FAMILY MEDICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 W MAIN ST
KALAMAZOO MI
49009-6114
US

IV. Provider business mailing address

6565 W MAIN ST
KALAMAZOO MI
49009-6114
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-0400
  • Fax: 269-372-8478
Mailing address:
  • Phone: 269-375-0400
  • Fax: 269-372-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA MARIE WILLIAMS
Title or Position: ADMINISTRATOR
Credential: MPA
Phone: 269-375-0400