1376691600 NPI number — MRS. CARRIE E REIF-BUSMAN PA

Table of content: MRS. CARRIE E REIF-BUSMAN PA (NPI 1376691600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376691600 NPI number — MRS. CARRIE E REIF-BUSMAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REIF-BUSMAN
Provider First Name:
CARRIE
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REIF
Provider Other First Name:
CARRIE
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376691600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 779
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAWAS CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48764-0779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-753-8453
Provider Business Mailing Address Fax Number:
989-753-3519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48601-2556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-754-3349
Provider Business Practice Location Address Fax Number:
989-755-1365
Provider Enumeration Date:
01/05/2007

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: 363AM0700X , with the licence number:  5601004876 , 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: 700G360400 . This is a "BX" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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