1760401848 NPI number — JOHN MICHAEL GARRETT MD PC

Table of content: (NPI 1760401848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760401848 NPI number — JOHN MICHAEL GARRETT MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN MICHAEL GARRETT MD PC
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:
GARRETT EYE CENTER
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:
1760401848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 CARPENTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRON MOUNTAIN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49801-4725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-774-1404
Provider Business Mailing Address Fax Number:
906-774-8132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 CARPENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRON MOUNTAIN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49801-4725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-774-1404
Provider Business Practice Location Address Fax Number:
906-774-8132
Provider Enumeration Date:
07/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARRETT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
906-774-1404

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901003320 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 2367-35 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 4301040476 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 28873-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X , with the licence number: 13429 , 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)