1093765737 NPI number — BECKER ORTHOPEDIC APPLIANCE COMPANY

Table of content: VIRGINIA GRACE GEAR RN (NPI 1083141501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093765737 NPI number — BECKER ORTHOPEDIC APPLIANCE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BECKER ORTHOPEDIC APPLIANCE COMPANY
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:
1093765737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4840
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48099-4840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-588-7480
Provider Business Mailing Address Fax Number:
248-588-6961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19251 MACK AVE
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
GROSSE POINTE WOODS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48236-2893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-640-7750
Provider Business Practice Location Address Fax Number:
313-640-7721
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOUSCANY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
248-588-7480

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 58003 . This is a "NPN PROVIDER NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4370206 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100106 . This is a "CARE CHOICES PROVIDER #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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