1871544577 NPI number — MAX WELL THERAPY L.L.C.

Table of content: (NPI 1871544577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871544577 NPI number — MAX WELL THERAPY L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAX WELL THERAPY L.L.C.
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:
MAX WELL PHYSICAL THERAPY & MASSAGE
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:
1871544577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1289 S LINDEN RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-230-9750
Provider Business Mailing Address Fax Number:
810-230-8799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1289 S LINDEN RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-230-9750
Provider Business Practice Location Address Fax Number:
810-230-8799
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAXWELL
Authorized Official First Name:
JILLAYNE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
810-230-9750

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0B511320 . This is a "BCBS GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0B50886 . This is a "BCBS OT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0B50901 . This is a "BCBS SP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1008285 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7368023 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383335 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 105378600 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4383090 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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