1861722548 NPI number — MICHIANA THERAPY SERVICES INCORPORATED

Table of content: (NPI 1861722548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861722548 NPI number — MICHIANA THERAPY SERVICES INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIANA THERAPY SERVICES INCORPORATED
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:
ORTHOPEDIC AND SPORTS PHYSICAL THERAPY
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:
1861722548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1828 HASS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46635-2042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-289-2030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 PIPESTONE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON HARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49022-2334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-925-9491
Provider Business Practice Location Address Fax Number:
269-925-9553
Provider Enumeration Date:
01/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ESPIRITU
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
HERNANDEZ
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
269-925-9491

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MI2570 . This is a "MEDICARE NUMBER (PTAN)" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com