1467475723 NPI number — KALAMAZOO OPHTHALMOLOGY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467475723 NPI number — KALAMAZOO OPHTHALMOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALAMAZOO OPHTHALMOLOGY 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:
Provider Other Organization Name Type Code:
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:
1467475723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3412 W CENTRE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTAGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49024-4624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-329-5860
Provider Business Mailing Address Fax Number:
269-329-5865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3412 W CENTRE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49024-4624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-329-5860
Provider Business Practice Location Address Fax Number:
269-329-5865
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIGGINS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
269-329-5860

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 180C960320 . This is a "BCBS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: FS003034 . This is a "FERRIS STANDIFORD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1863900012 . This is a "GREGORY BIBART" identifier . This identifiers is of the category "OTHER".
  • Identifier: 900C965580 . This is a "FERRIS STANDIFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: GB072121 . This is a "GREGORY BIBART" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1803906051 . This is a "GREGORY BIBART" identifier . This identifiers is of the category "OTHER".
  • Identifier: SH405954 . This is a "STEPHEN HIGGINS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2669516 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180C910010 . This is a "BCN GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4415148 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1803901811 . This is a "STEPHEN HIGGINS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4073524 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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