1013959345 NPI number — ALITA RICE MD PC

Table of content: (NPI 1013959345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013959345 NPI number — ALITA RICE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALITA RICE MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE PEDIATRIC PLACE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013959345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67000
Provider Second Line Business Mailing Address:
DEPT 253201
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-2532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-476-1788
Provider Business Mailing Address Fax Number:
248-476-1753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19840 MIDDLEBELT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48152-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-476-1788
Provider Business Practice Location Address Fax Number:
248-476-1753
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
ALITA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
248-476-1788

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301053820 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105147 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5097520 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4240023 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C5880 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3508288582 . This is a "BCBC BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: F64874 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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