1487686754 NPI number — CENTRAL MICHIGAN UNIVERSITY

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 1487686754 NPI number — CENTRAL MICHIGAN UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL MICHIGAN UNIVERSITY
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:
1487686754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 FOUST HL
Provider Second Line Business Mailing Address:
CENTRAL MICHIGAN UNIVERSITY HEALTH SERVICES
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48859-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-774-6599
Provider Business Mailing Address Fax Number:
989-774-4335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 FOUST HALL
Provider Second Line Business Practice Location Address:
CENTRAL MICHIGAN UNIVERSITY HEALTH SERVICES
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48859-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-774-1748
Provider Business Practice Location Address Fax Number:
989-774-4335
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STITES
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH INFO SPECIALIST
Authorized Official Telephone Number:
989-774-6599

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , 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: 0C76005 . This is a "BCBS NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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