1922006048 NPI number — HAMMOUD MEDICAL CENTER PC

Table of content: (NPI 1922006048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922006048 NPI number — HAMMOUD MEDICAL CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMMOUD MEDICAL CENTER 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:
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:
1922006048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 77700
Provider Second Line Business Mailing Address:
DEPT 77261
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48277-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-562-9588
Provider Business Mailing Address Fax Number:
313-562-9589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22146 FORD RD
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
DEARBORN HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48127-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-562-9588
Provider Business Practice Location Address Fax Number:
313-562-9589
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMOUD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
313-562-9588

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301078769 , 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: 1255330767 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080H223200 . This is a "BC GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080H223200 . This is a "BCN GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DC4758 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4650667 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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