1841304755 NPI number — ASPIRUS GRAND VIEW SERVICE CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841304755 NPI number — ASPIRUS GRAND VIEW SERVICE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPIRUS GRAND VIEW SERVICE CORPORATION
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:
ASPIRUS GRAND VIEW CLINIC DME
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:
1841304755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N10565 GRANDVIEW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRONWOOD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49938-9622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-932-1500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 GRANITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURLEY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54534-1372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-561-2255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHIANTELLO
Authorized Official First Name:
CHARMAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
906-932-2525

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: 41735200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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