1619960150 NPI number — MEDICAL ENTERPRISES, INC.

Table of content: (NPI 1619960150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619960150 NPI number — MEDICAL ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ENTERPRISES, INC.
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:
SCHEURER FAMILY VISION CENTER
Provider Other Organization Name Type Code:
3
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:
1619960150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7484 W. MICHIGAN AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIGEON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48755-0319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-453-2025
Provider Business Mailing Address Fax Number:
989-453-2166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7484 W MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIGEON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48755-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-453-2025
Provider Business Practice Location Address Fax Number:
989-453-2166
Provider Enumeration Date:
08/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LUTZ
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
C.F.O.
Authorized Official Telephone Number:
989-453-7301

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901002529 , 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: 943483401 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0C26506 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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