1730248410 NPI number — NORTH STREET MEDICAL CENTER P C

Table of content: DR. KATIE ELIZABETH CONNELL PH.D. (NPI 1891912960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730248410 NPI number — NORTH STREET MEDICAL CENTER P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH STREET MEDICAL CENTER 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:
6
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:
1730248410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1457 N. M-52
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
OWOSSO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-723-5136
Provider Business Mailing Address Fax Number:
989-723-8269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1457 N. M-52
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
OWOSSO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-723-5136
Provider Business Practice Location Address Fax Number:
989-723-8269
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLANDERS
Authorized Official First Name:
JODI
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PHYSICIAN & PRACTICE OWNER
Authorized Official Telephone Number:
989-723-5136

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; 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