1811421563 NPI number — UNITED MEDICAL

Table of content: MRS. BETTY ANN MACHA RN, BSN, MS (NPI 1154448728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811421563 NPI number — UNITED MEDICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED MEDICAL
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:
1811421563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15565 NORTHLAND DRIVE
Provider Second Line Business Mailing Address:
503E
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-759-5157
Provider Business Mailing Address Fax Number:
313-694-3590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15565 NORTHLAND DRIVE
Provider Second Line Business Practice Location Address:
503 EAST
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-759-5157
Provider Business Practice Location Address Fax Number:
313-694-3590
Provider Enumeration Date:
04/19/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EUBANKS
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-759-5157

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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