1649278748 NPI number — BRIGHTON FAMILY PHYSICIANS PC

Table of content: (NPI 1649278748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649278748 NPI number — BRIGHTON FAMILY PHYSICIANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTON FAMILY PHYSICIANS PC
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:
Provider Other Organization Name Type Code:
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:
1649278748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 E GRAND RIVER AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48116-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-225-7773
Provider Business Mailing Address Fax Number:
810-225-7774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 E GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48116-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-225-7773
Provider Business Practice Location Address Fax Number:
810-225-7774
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RUPP
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
810-225-7773

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301063298 , 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: 610855700 . This is a "DEPT OF LABOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00068445 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0D71085 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080D710850 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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