1851561773 NPI number — NORTHERN ONCOLOGY SERVICES PLLC

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 1851561773 NPI number — NORTHERN ONCOLOGY SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ONCOLOGY SERVICES PLLC
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:
MEDICAL SPECIALTY ASSOCIATES PC
Provider Other Organization Name Type Code:
4
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:
1851561773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 MICHIGAN ST NE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49503-5721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-456-8115
Provider Business Mailing Address Fax Number:
616-456-1079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 MICHIGAN ST NE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-5721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-456-8115
Provider Business Practice Location Address Fax Number:
616-456-1079
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PAWL
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
616-456-8115

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301038152 , 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: 2991200 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com