1720114663 NPI number — MIDDLE FLINT AREA COUNCIL ON AGING INC.

Table of content: JOSHUA DAVID MAZUREK DC (NPI 1508527540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720114663 NPI number — MIDDLE FLINT AREA COUNCIL ON AGING INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLE FLINT AREA COUNCIL ON AGING 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:
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:
1720114663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 GA HIGHWAY 27 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMERICUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31709-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-928-2126
Provider Business Mailing Address Fax Number:
229-924-0304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 GA HIGHWAY 27 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERICUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31709-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-928-2126
Provider Business Practice Location Address Fax Number:
229-924-0304
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRAVES
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
229-928-2126

Provider Taxonomy Codes

  • Taxonomy code: 332U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com