1164442109 NPI number — DR. JAMES M REAUME JR. M.D.

Table of content: DR. JAMES M REAUME JR. M.D. (NPI 1164442109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164442109 NPI number — DR. JAMES M REAUME JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REAUME
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1164442109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONTONAGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49953-1459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-884-8000
Provider Business Mailing Address Fax Number:
906-337-6597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONTONAGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49953-1459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-884-8000
Provider Business Practice Location Address Fax Number:
906-337-6597
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  JR050177 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 135697200 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01349 . This is a "PRIORITY HEALTH PAY TO #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104424998 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23-8650 . This is a "RHC CERTIFICATION NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 105206868 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383218134 . This is a "TRICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700C460070 . This is a "BCBS OF MI GROUP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700E260160 . This is a "BCBS OF MI" identifier . This identifiers is of the category "OTHER".




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