Healthcare Provider Details

I. General information

NPI: 1477640720
Provider Name (Legal Business Name): WEST MICHIGAN CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PARK ST
KALAMAZOO MI
49007-3731
US

IV. Provider business mailing address

601 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 264-382-2500
  • Fax:
Mailing address:
  • Phone: 269-341-7806
  • Fax: 269-341-8743

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: MS. TERRY MCKAY
Title or Position: PRESIDENT
Credential:
Phone: 269-382-2500