1538166186 NPI number — MRS. AMY CATHERINE ROY NPC

Table of content: MRS. AMY CATHERINE ROY NPC (NPI 1538166186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538166186 NPI number — MRS. AMY CATHERINE ROY NPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
AMY
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANGLIN
Provider Other First Name:
AMY
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538166186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
431 SWARTZ CT. STE. 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-841-2615
Provider Business Mailing Address Fax Number:
616-828-1752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 SWARTZ CT. STE. 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-841-2615
Provider Business Practice Location Address Fax Number:
616-828-1752
Provider Enumeration Date:
06/28/2005

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: 363LF0000X , with the licence number:  4704217807 , 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: 4636668-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".