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General NPI Number Information
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NPI Number | 1801843974
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Entity Type | Organization
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Legal Business Name | MIDWEST EMERGENCY DEPARTMENT SERVICES INC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 211 S 3RD ST
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City | BELLEVILLE
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State | IL
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Zip | 62220-1915
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Country | US
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Telephone | 618-234-2120
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8882
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City | FORT WORTH
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State | TX
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Zip | 76124-0882
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Country | US
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Telephone | 817-451-4208
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM W CRUZEN
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Credential | DO
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Telephone | 618-624-3368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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