1740219609 NPI number — GEERTRUIDA C ROER GNP

Table of content: GEERTRUIDA C ROER GNP (NPI 1740219609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740219609 NPI number — GEERTRUIDA C ROER GNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROER
Provider First Name:
GEERTRUIDA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
GNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEULE
Provider Other First Name:
GEERTRUIDA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740219609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2640 87TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BYRON CENTER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49315-9236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-878-1313
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28800 RYAN RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48092-4272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-620-8100
Provider Business Practice Location Address Fax Number:
866-227-7418
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  4704142979 , 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: 500024152 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 500F410070 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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