1699960013 NPI number — SELECT HEALTH, P.C.

Table of content: (NPI 1699960013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699960013 NPI number — SELECT HEALTH, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELECT HEALTH, 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:
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:
1699960013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
436 MARSHALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLDWATER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49036-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-278-6600
Provider Business Mailing Address Fax Number:
517-278-0600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
436 MARSHALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49036-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-278-6600
Provider Business Practice Location Address Fax Number:
517-278-0600
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITAKER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
517-278-6600

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1639129646 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1821054966 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144262122 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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