1942393475 NPI number — NORTH OAKLAND ASC LLC

Table of content: (NPI 1942393475)

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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