1326056003 NPI number — SAMANTHA M MUCHA MD

Table of content: SAMANTHA M MUCHA MD (NPI 1326056003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326056003 NPI number — SAMANTHA M MUCHA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUCHA
Provider First Name:
SAMANTHA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1326056003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SEAGATE
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-1558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
567-585-1918
Provider Business Mailing Address Fax Number:
419-824-7359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 KIMOLE LN
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
ADRIAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49221-1478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-263-9491
Provider Business Practice Location Address Fax Number:
517-263-9591
Provider Enumeration Date:
08/04/2006

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: 207Y00000X , with the licence number:  4301088792 , 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: 000000493280 . This is a "ANTHEM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0404610882 . This is a "BCBS MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 06316 . This is a "PARAMOUNT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 156940 . This is a "GLHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4928260 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00357849 . This is a "RRMC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 144133 . This is a "CARE CHOICE PREFERRED C" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7819885 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40042 . This is a "HPM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4907804 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".