1972092831 NPI number — BELLIN HEALTH IRON MOUNTAIN INC

Table of content: (NPI 1972092831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972092831 NPI number — BELLIN HEALTH IRON MOUNTAIN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLIN HEALTH IRON MOUNTAIN INC
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:
BELLIN HEALTH GLADSTONE
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:
1972092831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22487
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54305-2487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-445-7226
Provider Business Mailing Address Fax Number:
920-445-7229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 MINNEAPOLIS AVE STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLADSTONE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49837-2060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-776-5640
Provider Business Practice Location Address Fax Number:
906-776-5639
Provider Enumeration Date:
05/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
STROOBANTS
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
920-445-7226

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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