1124064506 NPI number — RODNEY D MICHAELS MD PC

Table of content: MR. DENNIS E. MCGINTY PT (NPI 1982706024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124064506 NPI number — RODNEY D MICHAELS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RODNEY D MICHAELS MD 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:
6
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:
1124064506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1585 LIBERTY ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97302-4345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-589-0565
Provider Business Mailing Address Fax Number:
503-589-0463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1585 LIBERTY ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97302-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-589-0565
Provider Business Practice Location Address Fax Number:
503-589-0463
Provider Enumeration Date:
06/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MICHAELS
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-589-0565

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  MD16437 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1386691061 . This is a "DR MICHAELS NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 058292 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1699715227 . This is a "BARBARA BRITSCH NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 137534 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".