1205834116 NPI number — MOLLY M MUIR CNM

Table of content: MOLLY M MUIR CNM (NPI 1205834116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205834116 NPI number — MOLLY M MUIR CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUIR
Provider First Name:
MOLLY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

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:
1205834116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44405 WOODWARD AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48341-5023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-858-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1794 N LAPEER RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAPEER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48446-7664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-969-4501
Provider Business Practice Location Address Fax Number:
810-969-4407
Provider Enumeration Date:
07/13/2005

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: 367A00000X , with the licence number:  4704212262 , 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: 05225 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 344428256 . This is a "FRONTPATH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 344428256087 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000356101 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2528545 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 344428256 . This is a "BEECHSTREET" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4638608 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4638617 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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