1811197593 NPI number — HASTINGS ORTHOPEDIC CLINIC

Table of content: (NPI 1811197593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811197593 NPI number — HASTINGS ORTHOPEDIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HASTINGS ORTHOPEDIC CLINIC
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:
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:
1811197593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 COOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASTINGS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49058-9616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-945-4966
Provider Business Mailing Address Fax Number:
269-945-3368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 COOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49058-9616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-945-4966
Provider Business Practice Location Address Fax Number:
269-945-3368
Provider Enumeration Date:
07/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MERRIMAN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
269-945-4966

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101378087 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114206086 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205872959 . This is a "ESL NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1881639839 . This is a "JLH NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200005744 . This is a "MCR RR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540Z810220 . This is a "BCBS DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200044303 . This is a "MCR RR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1346373065 . This is a "GROUP NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200Z800130 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 114316909 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467480152 . This is a "KSM NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1811197593 . This is a "HOC DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 250011404 . This is a "MCR RR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 874704973 . This is a "MCD DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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