1518998772 NPI number — MARY B. SEGER N.P.

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 1518998772 NPI number — MARY B. SEGER N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGER
Provider First Name:
MARY
Provider Middle Name:
B.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEGER-NOSS
Provider Other First Name:
MARY
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518998772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
829 N CENTER AVE
Provider Second Line Business Mailing Address:
SUITE 298
Provider Business Mailing Address City Name:
GAYLORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49735-1595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-731-7708
Provider Business Mailing Address Fax Number:
989-731-7929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
829 N CENTER AVE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
GAYLORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49735-1595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-731-7870
Provider Business Practice Location Address Fax Number:
989-731-7837
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  47404155037 , 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: 1156900045 . This is a "BCBSM PROVIDER NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OF96004 . This is a "MEDICARE GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381303843 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: CC4805 . This is a "MEDICARE RR PROV ID" identifier . This identifiers is of the category "OTHER".




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