Healthcare Provider Details

I. General information

NPI: 1427096684
Provider Name (Legal Business Name): MICHIGAN EM-I MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 MYRTLE ST
STURGIS MI
49091-2326
US

IV. Provider business mailing address

PO BOX 41779
PHILADELPHIA PA
19101-1779
US

V. Phone/Fax

Practice location:
  • Phone: 269-651-7824
  • Fax: 269-659-6738
Mailing address:
  • Phone: 800-732-1066
  • Fax: 630-941-4333

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: DR. DOUGLAS P WEBSTER
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 800-732-1066