1730117805 NPI number — ASCENSION MEDICAL GROUP MICHIGAN

Table of content: (NPI 1730117805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730117805 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:
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:
1730117805
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:
28000 DEQUINDRE ROAD
Provider Second Line Business Practice Location Address:
REVENUE CYCLE DEPARTMENT
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-680-8000
Provider Business Practice Location Address Fax Number:
248-292-3852
Provider Enumeration Date:
06/29/2006

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:
248-680-8121

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 080F334280 . This is a "BCBSM GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".