1881613040 NPI number — SPECIALISTS IN ORTHOPEDIC SURGERY PLLC

Table of content: (NPI 1881613040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881613040 NPI number — SPECIALISTS IN ORTHOPEDIC SURGERY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALISTS IN ORTHOPEDIC SURGERY 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:
Provider Other Organization Name Type Code:
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:
1881613040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WILLIAM CARLS DR
Provider Second Line Business Mailing Address:
RSC @ HVSH
Provider Business Mailing Address City Name:
COMMERCE TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48382-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-937-4947
Provider Business Mailing Address Fax Number:
248-937-5150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WILLIAM CARLS DR
Provider Second Line Business Practice Location Address:
RSC @ HVSH
Provider Business Practice Location Address City Name:
COMMERCE TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48382-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-937-4947
Provider Business Practice Location Address Fax Number:
248-937-5150
Provider Enumeration Date:
07/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HATHORNE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
248-937-3411

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0F37461 . This is a "BCBSMI GROUP ID#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F32656 . This is a "BCBSMI DME SUPPLIER ID#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5606110 . This is a "ADMINISTAR FEDERAL DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5606110003 . This is a "ADMINISTAR FEDERAL DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".