1639177058 NPI number — BRUCE E ADAMS DO & ASSOCIATES, P.C.

Table of content: (NPI 1639177058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639177058 NPI number — BRUCE E ADAMS DO & ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE E ADAMS DO & ASSOCIATES, 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:
DR BRUCE E ADAMS DO
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:
1639177058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23421 RYAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48091-1927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-756-1921
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23421 RYAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48091-1927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-756-3111
Provider Business Practice Location Address Fax Number:
586-756-1921
Provider Enumeration Date:
07/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRINCIPLE PHYSICIAN
Authorized Official Telephone Number:
586-756-3111

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5101004370 , 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: 1015886 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285639856 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0855000074 . This is a "BCBS FAMILY PRACTICE ID" identifier . This identifiers is of the category "OTHER".




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