1871524652 NPI number — ALYNE R MCCANN FNP

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 1871524652 NPI number — ALYNE R MCCANN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCANN
Provider First Name:
ALYNE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAGGARD
Provider Other First Name:
ALYNE
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871524652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 LAPEER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48607-1208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-759-6464
Provider Business Mailing Address Fax Number:
989-399-8233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3884 MONITOR ROAD
Provider Second Line Business Practice Location Address:
BAYSIDE COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48706-9298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-671-2000
Provider Business Practice Location Address Fax Number:
989-671-4000
Provider Enumeration Date:
07/06/2006

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: 363L00000X , with the licence number:  4704138353 , 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: 381908328325 . This is a "CCM OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328328 . This is a "CCM OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4852297 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018240 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328326 . This is a "CCM OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: TYPE 77 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 381908328327 . This is a "CCM OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 153963 . This is a "GREAT LAKES HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1871524652 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 381908328324 . This is a "CCM OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500G310570 . This is a "BCBS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".




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