1487686754 NPI number — CENTRAL MICHIGAN UNIVERSITY

Table of content: (NPI 1487686754)

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: 207Q00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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".