1235181223 NPI number — AMERICAN ANESTHESIOLOGY ASSOCIATES OF MICHIGAN, PC

Table of content: (NPI 1235181223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235181223 NPI number — AMERICAN ANESTHESIOLOGY ASSOCIATES OF MICHIGAN, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN ANESTHESIOLOGY ASSOCIATES OF MICHIGAN, 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:
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:
1235181223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2432 GENESYS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-8069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-606-6499
Provider Business Mailing Address Fax Number:
810-606-7245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GENESYS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-8065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-606-6499
Provider Business Practice Location Address Fax Number:
810-606-7245
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRENT
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-606-6499

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 430B510910 . This is a "BCBS CRNAS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0024559 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: AN380006 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 050B546530 . This is a "BCBS ANESTHESIOLOGISTS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5462446 . This is a "AETNA ANESTHESIOLOGISTS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7910648 . This is a "AETNA CRNAS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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