1831143262 NPI number — DR. WENDELL J HYINK M.D.

Table of content: DR. WENDELL J HYINK M.D. (NPI 1831143262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831143262 NPI number — DR. WENDELL J HYINK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYINK
Provider First Name:
WENDELL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1831143262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 458
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NILES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49120-0458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-684-0259
Provider Business Mailing Address Fax Number:
269-684-0189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 N SAINT JOSEPH AVE
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49120-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-684-1432
Provider Business Practice Location Address Fax Number:
269-684-0259
Provider Enumeration Date:
05/20/2006

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: 207L00000X , with the licence number:  4301037510 , 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: 1356370241 . This is a "GROUP NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 050A111210 . This is a "GROUP BCBS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0M30900 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1831143262 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: M30900008 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: WH037510 . This is a "INDIVIDUAL BCBS LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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