Provider Demographics
NPI:1215103312
Name:BRONSON METHODIST HOSPITAL
Entity type:Organization
Organization Name:BRONSON METHODIST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAMMER
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:269-341-8938
Mailing Address - Street 1:820 JOHN ST
Mailing Address - Street 2:102
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2870
Mailing Address - Country:US
Mailing Address - Phone:269-341-8938
Mailing Address - Fax:269-341-7556
Practice Address - Street 1:820 JOHN ST
Practice Address - Street 2:102
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2870
Practice Address - Country:US
Practice Address - Phone:269-341-8938
Practice Address - Fax:269-341-7556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRONSON METHODIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002577282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital