1750500526 NPI number — METROPOLITAN ANESTHESIA ASSOCIATES, PC

Table of content: (NPI 1750500526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750500526 NPI number — METROPOLITAN ANESTHESIA ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN ANESTHESIA ASSOCIATES, 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:
1750500526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 ANN ST NW
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49504-2052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-808-3944
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 BOSTON ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49506-4160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-252-7103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
VANESSA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
616-808-3944

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1912960675 . This is a "DAVID KNIGHT CRNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1679536718 . This is a "TERESA KOELZER CRNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4349131 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4718235 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477522670 . This is a "LAREE DEPIES CRNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1598728636 . This is a "SUSAN RUTHERFORD CRNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4322138 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4537409 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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