1790004166 NPI number — VERITAS GROUP LLC

Table of content: (NPI 1790004166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790004166 NPI number — VERITAS GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERITAS GROUP LLC
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:
COMPREHENSIVE EAR AND HEARING CENTER OF HOLLAND
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:
1790004166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 S STATE ST STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZEELAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49464-1677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-393-5482
Provider Business Mailing Address Fax Number:
616-393-5483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S STATE ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEELAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49464-1677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-772-1986
Provider Business Practice Location Address Fax Number:
616-772-1844
Provider Enumeration Date:
05/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VANHARKEN
Authorized Official First Name:
CARLI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
616-772-1986

Provider Taxonomy Codes

  • Taxonomy code: 207YX0007X , with the licence number:  TD038705 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0007X , with the licence number: 4301038705 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 1601000182 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 3501003169 , 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)





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