1821264060 NPI number — MARCY C SCHLINGER D O LLC

Table of content: (NPI 1821264060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821264060 NPI number — MARCY C SCHLINGER D O LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARCY C SCHLINGER D O 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:
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:
1821264060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4655 DOBIE RD
Provider Second Line Business Mailing Address:
STE. 270
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48864-2233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-381-5360
Provider Business Mailing Address Fax Number:
517-381-5362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4655 DOBIE RD
Provider Second Line Business Practice Location Address:
STE. 270
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-2233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-381-5360
Provider Business Practice Location Address Fax Number:
517-381-5362
Provider Enumeration Date:
05/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHLINGER
Authorized Official First Name:
MARCY
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-381-5360

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  011632 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 011632 , 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: 1009116 . This is a "MCLAREN HEALTH PLAN-HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2553310134 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 114673901 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200000002667 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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