Provider Demographics
NPI:1215111091
Name:MERCY CARE OF WEST MICHIGAN INC
Entity type:Organization
Organization Name:MERCY CARE OF WEST MICHIGAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-672-6950
Mailing Address - Street 1:1560 E SHERMAN BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1867
Mailing Address - Country:US
Mailing Address - Phone:231-672-3660
Mailing Address - Fax:231-672-3630
Practice Address - Street 1:1560 E SHERMAN BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1867
Practice Address - Country:US
Practice Address - Phone:231-672-3660
Practice Address - Fax:231-672-3630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY GENERAL HEALTH PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012374261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine