1306850854 NPI number — OAKWOOD HEALTHCARE, INC.

Table of content: MERCEDES ROMERO PA-C (NPI 1902517915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306850854 NPI number — OAKWOOD HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKWOOD HEALTHCARE, 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:
BEAUMONT HOSPITAL - TAYLOR
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:
1306850854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26901 BEAUMONT BLVD.
Provider Second Line Business Mailing Address:
COMPLIANCE
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48033-4617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
947-522-1963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48180-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-295-5000
Provider Business Practice Location Address Fax Number:
313-295-5085
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ODOM
Authorized Official First Name:
LEE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT SHARED SERVICES
Authorized Official Telephone Number:
947-522-3326

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  820250 , 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: 110242874 . This is a "RAIL ROAD PROFESSIONAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OP821177 . This is a "M-CARE PROFESSIONAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 113074760 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00000001147A . This is a "CAPE HEALTH PROFESSIONAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0Q24603 . This is a "BSHIELD/BCN PROFESSIONAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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