1730511346 NPI number — DIRECT PATH SERVICES, P.C.

Table of content: (NPI 1730511346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730511346 NPI number — DIRECT PATH SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIRECT PATH SERVICES, P.C.
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:
1730511346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30200 TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
BINGHAM FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48025-4502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-220-4425
Provider Business Mailing Address Fax Number:
248-220-4428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30200 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
BINGHAM FARMS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48025-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-220-4425
Provider Business Practice Location Address Fax Number:
248-220-4428
Provider Enumeration Date:
08/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWIMER
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT/LABORATORY DIRECTOR
Authorized Official Telephone Number:
248-220-4425

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  5101015559 , 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: 1730511346 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0H70792 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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