1396910956 NPI number — RICHARD HAINER

Table of content: (NPI 1396910956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396910956 NPI number — RICHARD HAINER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD HAINER
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:
NORTH OAKLAND PLASTIC SURGERY
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:
1396910956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1349 S ROCHESTER RD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-3150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-601-4240
Provider Business Mailing Address Fax Number:
248-601-4234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1349 S ROCHESTER RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-3150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-601-4240
Provider Business Practice Location Address Fax Number:
248-601-4234
Provider Enumeration Date:
04/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAINER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
248-601-4240

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , with the licence number:  4301056609 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: 4301056609 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0105X , with the licence number: 4301056609 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: 4301056609 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2406337442 . This is a "BCBBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1821017963 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: RH056609 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F37932 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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