1578741252 NPI number — INTEGRATED HEALTH CARE OF CHELSEA, P.C.

Table of content: (NPI 1578741252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578741252 NPI number — INTEGRATED HEALTH CARE OF CHELSEA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTH CARE OF CHELSEA, P.C.
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:
INTEGRATED HEALTH CARE OF CHELSEA
Provider Other Organization Name Type Code:
5
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:
1578741252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1290 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
CHELSEA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48118-1454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-475-1107
Provider Business Mailing Address Fax Number:
734-475-9230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1290 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48118-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-475-1107
Provider Business Practice Location Address Fax Number:
734-475-9230
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GLEESPEN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-475-1107

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MG048067 , 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: 3253813 TYPE 10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: MG048067 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com