1083607139 NPI number — HOUGHTON COUNTY MEDICAL CARE FACILITY

Table of content: (NPI 1083607139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083607139 NPI number — HOUGHTON COUNTY MEDICAL CARE FACILITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUGHTON COUNTY MEDICAL CARE FACILITY
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:
CANAL VIEW HOUGHTON COUNTY
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:
1083607139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 W QUINCY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANCOCK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49930-1404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-482-5050
Provider Business Mailing Address Fax Number:
906-482-4609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 W QUINCY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANCOCK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49930-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-482-5050
Provider Business Practice Location Address Fax Number:
906-482-4609
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRISEBOIS
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SENIOR BILLING SPECIALIST
Authorized Official Telephone Number:
906-483-2153

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  318510 , 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: 2085034 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09620 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com