1326096629 NPI number — REGENTS OF THE UNIVERSITY OF MICHIGAN

Table of content: KAREN MARIE SASSO CNS (NPI 1265642466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326096629 NPI number — REGENTS OF THE UNIVERSITY OF MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS OF THE UNIVERSITY OF MICHIGAN
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:
6
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:
1326096629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 223248
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-2248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-975-3006
Provider Business Mailing Address Fax Number:
734-975-3079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2850 S. INDUSTRIAL HWY.
Provider Second Line Business Practice Location Address:
SUITE 50
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48104-9821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-975-3006
Provider Business Practice Location Address Fax Number:
734-975-3079
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-936-3568

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  5301005698 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: 5301005698 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 5301005698 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 5301005698 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301005698 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 5301005698 , 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: 0883058 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4470923 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2349973 . This is a "NCPDP/NAPB" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 470H10006 . This is a "BCBS OF MICHIGAN - HIT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540H103110 . This is a "BCBS OF MI - DME SUPPLIES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01000482 . This is a "HEALTH PLUS OF MI - MCD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104041 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 874887962 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470H100060 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 504887962 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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