1235208075 NPI number — NORTHWEST MICHIGAN HEALTH SERVICES INC.

Table of content: (NPI 1235208075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235208075 NPI number — NORTHWEST MICHIGAN HEALTH SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST MICHIGAN HEALTH SERVICES 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:
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:
1235208075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 S STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49455-1243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-861-2139
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 S STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49455-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-861-2139
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRITTON
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
231-947-1112

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , with the licence number: 5601004803 , 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: 2930590 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4899909 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4109055 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5197132 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4109046 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4410670 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4518234 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3291322 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4410689 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4301085193 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4202541 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4704133105 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4704076658 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2932773 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4518225 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4704127539 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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