1396832549 NPI number — GENESEE CARE L.L.C.

Table of content: (NPI 1396832549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396832549 NPI number — GENESEE CARE L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESEE CARE L.L.C.
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:
THE SURGERY CENTER OF GENESEE COUNTY
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:
1396832549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5202 MILLER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507-1040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-732-7700
Provider Business Mailing Address Fax Number:
810-733-5840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5202 MILLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48507-1040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-732-7700
Provider Business Practice Location Address Fax Number:
810-733-5840
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROCHU
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
810-732-7700

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  256821 , 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: 0185138 . This is a "LABOR & INDUSTRY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: AS250001 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40361 . This is a "BCN OF EAST MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0981787 . This is a "HEALTHPLUS OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1001783 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40361 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5286614 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1001783 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0981787 . This is a "HEALTHPLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0981787 . This is a "HEALTHPLUS PARTNERS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0981787 . This is a "HEALTHPLUS SENIOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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