1134403694 NPI number — MOLLY BUIST & ASSOCIATES INC

Table of content: (NPI 1134403694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134403694 NPI number — MOLLY BUIST & ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOLLY BUIST & ASSOCIATES INC
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:
THE CENTER FOR CHILDHOOD DEVELOPMENT
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:
1134403694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7086 8TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JENISON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49428-9352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-667-9551
Provider Business Mailing Address Fax Number:
616-667-9552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7086 8TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENISON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49428-9352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-667-9551
Provider Business Practice Location Address Fax Number:
616-667-8552
Provider Enumeration Date:
10/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BUIST
Authorized Official First Name:
MOLLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST/OWNER
Authorized Official Telephone Number:
616-667-9551

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  5201001977 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: 5201007232 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 5201000987 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 09130441 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 12005914 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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