1619029923 NPI number — HAND SURGERY OF NORTHERN MICHIGAN PLC

Table of content: (NPI 1619029923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619029923 NPI number — HAND SURGERY OF NORTHERN MICHIGAN PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAND SURGERY OF NORTHERN MICHIGAN PLC
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:
TRAVERSE BAY HAND THERAPY PLC
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:
1619029923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 W FRONT ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-2236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-995-9758
Provider Business Mailing Address Fax Number:
231-995-9745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 W FRONT ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49684-2236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-995-9758
Provider Business Practice Location Address Fax Number:
231-995-9745
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
231-995-9748

Provider Taxonomy Codes

  • Taxonomy code: 2251H1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0B81023 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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