1972744100 NPI number — OP THERAPY, LLC

Table of content: (NPI 1972744100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972744100 NPI number — OP THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OP THERAPY, 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:
IN-HOUSE DIAGNOSTIC SOLUTIONS
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:
1972744100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7760 KOCHVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREELAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48623-8655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-695-6626
Provider Business Mailing Address Fax Number:
517-695-6873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7760 KOCHVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREELAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48623-8655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-695-6626
Provider Business Practice Location Address Fax Number:
517-695-6873
Provider Enumeration Date:
03/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COOKE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-950-3005

Provider Taxonomy Codes

  • Taxonomy code: 246X00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 246XC2903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 700G300780 . This is a "BCBSM PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00816164 . This is a "MEDICARE RAILROAD IDTF (ONE PER TAX ID)" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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