1770781536 NPI number — JULIE SIMPSON DPT

Table of content: JULIE SIMPSON DPT (NPI 1770781536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770781536 NPI number — JULIE SIMPSON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMPSON
Provider First Name:
JULIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

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:
1770781536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 323
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOWLERVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48836-0323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-545-3200
Provider Business Mailing Address Fax Number:
517-545-3236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 W GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48843-3975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-545-3200
Provider Business Practice Location Address Fax Number:
517-545-3236
Provider Enumeration Date:
07/03/2007

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: 225100000X , with the licence number:  5423 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 5501015556 , 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: 243077 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00617752 . This is a "RRMC" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 084171026 . This is a "BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com