1417004003 NPI number — IHA HEALTH SERVICES CORPORATION

Table of content: (NPI 1417004003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417004003 NPI number — IHA HEALTH SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IHA HEALTH SERVICES CORPORATION
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:
TRINITY HEALTH IHA MEDICAL GROUP PEDIATRICS
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:
1417004003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 FRANK LLOYD WRIGHT DR # J2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48105-9484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-747-6766
Provider Business Mailing Address Fax Number:
734-222-3100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4350 JACKSON RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48103-1889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-971-9344
Provider Business Practice Location Address Fax Number:
734-971-2303
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIOTT
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP / CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
734-747-6766

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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