1871782136 NPI number — CASEY R BARTMAN MD PC

Table of content: (NPI 1871782136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871782136 NPI number — CASEY R BARTMAN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASEY R BARTMAN MD PC
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:
ORTHOPAEDIC & SPINAL ASSOCIATES
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:
1871782136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 KENMOOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-956-7716
Provider Business Mailing Address Fax Number:
616-956-0839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 KENMOOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-956-7716
Provider Business Practice Location Address Fax Number:
616-956-0839
Provider Enumeration Date:
10/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARTMAN
Authorized Official First Name:
CASEY
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
616-956-7716

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  CB047651 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 047651 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0411356 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1422 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 101730719 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730719 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004113561 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2004113561 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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