1942393475 NPI number — NORTH OAKLAND ASC LLC

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 1942393475 NPI number — NORTH OAKLAND ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH OAKLAND ASC LLC
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:
1942393475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
461 WEST HURON ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48341-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-857-7583
Provider Business Mailing Address Fax Number:
248-857-7588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 NORTH OAKLAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48327-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-666-5552
Provider Business Practice Location Address Fax Number:
248-666-5549
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DERUBEIS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
248-857-7583

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  636823 , 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: 141676 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 17412 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40347 . This is a "BCBS - FACILITY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 490F32891 . This is a "BCBS - PROFESSIONAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B0100 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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