1467566364 NPI number — MYMICHIGAN MEDICAL CENTER ALPENA

Table of content: (NPI 1467566364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467566364 NPI number — MYMICHIGAN MEDICAL CENTER ALPENA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYMICHIGAN MEDICAL CENTER ALPENA
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:
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:
1467566364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 WELLNESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48670-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-356-8079
Provider Business Mailing Address Fax Number:
989-356-8076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 W CHISHOLM ST
Provider Second Line Business Practice Location Address:
OUTPATIENT PHARMACY
Provider Business Practice Location Address City Name:
ALPENA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49707-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-356-8079
Provider Business Practice Location Address Fax Number:
989-356-8076
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HICKOK
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
OUTPATIENT PHARMACY MANAGER
Authorized Official Telephone Number:
989-356-8079

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5302021206 , 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: 2312128 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com