1386710705 NPI number — WESTERN MICHIGAN UNIVERSITY UNIFIED CLINICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386710705 NPI number — WESTERN MICHIGAN UNIVERSITY UNIFIED CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MICHIGAN UNIVERSITY UNIFIED CLINICS
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:
1386710705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 OAKLAND DR FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49008-1282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-387-8047
Provider Business Mailing Address Fax Number:
269-387-7026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 OAKLAND DR FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49008-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-387-8047
Provider Business Practice Location Address Fax Number:
269-387-7026
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUNDBERG
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
269-387-7005

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4631868 . This is a "IBA INSURANCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 640C926130 . This is a "TC BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 155811 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46 31868 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40 4702665 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46 31868 . This is a "PHYISICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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