1972566594 NPI number — ORTHOPAEDIC ASSOCIATES OF MUSKEGON, PC

Table of content: (NPI 1972566594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972566594 NPI number — ORTHOPAEDIC ASSOCIATES OF MUSKEGON, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC ASSOCIATES OF MUSKEGON, 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:
1972566594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 MERCY DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49444-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-733-1326
Provider Business Mailing Address Fax Number:
231-830-2764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 MERCY DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49444-1836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-733-1326
Provider Business Practice Location Address Fax Number:
231-830-2764
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FULLER
Authorized Official First Name:
LORAL
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
231-830-2729

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0N94170 . This is a "MEDICARE GROUP PROVIDER #" identifier . This identifiers is of the category "OTHER".




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