1699102632 NPI number — I PRIORITY PT LLC

Table of content: (NPI 1699102632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699102632 NPI number — I PRIORITY PT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
I PRIORITY PT LLC
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:
1699102632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16300 N PARK DR APT 1205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075-4724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-569-1885
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21700 GREENFIELD RD STE 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48237-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-569-1335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALONE
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
248-569-1335

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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