1124255963 NPI number — ELIZABETH K FEY PA-C

Table of content: ELIZABETH K FEY PA-C (NPI 1124255963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124255963 NPI number — ELIZABETH K FEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEY
Provider First Name:
ELIZABETH
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACOBS
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124255963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 BYRON CENTER AVE SW
Provider Second Line Business Mailing Address:
MEDICAL ADMINISTRATION
Provider Business Mailing Address City Name:
WYOMING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49519-9606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-252-3243
Provider Business Mailing Address Fax Number:
616-252-0260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11160 WJ PRESLEY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENDALE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49401-8074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-252-3900
Provider Business Practice Location Address Fax Number:
616-252-3920
Provider Enumeration Date:
06/19/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  5601005515 , 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)