1003831918 NPI number — OAKDELL MEDICAL SERVICES

Table of content: (NPI 1003831918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003831918 NPI number — OAKDELL MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKDELL MEDICAL SERVICES
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:
MICHAEL K OBASI
Provider Other Organization Name Type Code:
5
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:
1003831918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 AURELIUS RD
Provider Second Line Business Mailing Address:
SUITE 3A
Provider Business Mailing Address City Name:
HOLT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48842-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-694-8808
Provider Business Mailing Address Fax Number:
517-694-8868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 AURELIUS RD
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
HOLT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48842-1380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-694-8808
Provider Business Practice Location Address Fax Number:
517-694-8868
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OBASI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
KALU
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-694-8808

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120457094 . This is a "TRICARE NORTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4962950 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: TXW 0013701 . This is a "BEDDING LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 54-C3-1417-0 . This is a "BCBS BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1003831918 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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