1720233968 NPI number — ASCENSION MEDICAL GROUP MICHIGAN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720233968 NPI number — ASCENSION MEDICAL GROUP MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION MEDICAL GROUP MICHIGAN
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:
MACOMB SLEEP INSTITUTE
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:
1720233968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-680-8000
Provider Business Mailing Address Fax Number:
248-292-3852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17900 23 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
MACOMB
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48044-1161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-868-9075
Provider Business Practice Location Address Fax Number:
586-868-9077
Provider Enumeration Date:
12/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STARKEL
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
248-680-8000

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , 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: 700E012740 . This is a "BCBSM GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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