1033855440 NPI number — PARAMOUNT REHABILITATION SERVICES, PC

Table of content: (NPI 1033855440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033855440 NPI number — PARAMOUNT REHABILITATION SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAMOUNT REHABILITATION SERVICES, 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:
6
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:
1033855440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESANING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48616-1252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-323-2090
Provider Business Mailing Address Fax Number:
989-323-3991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESANING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48616-1252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-323-2090
Provider Business Practice Location Address Fax Number:
989-323-3991
Provider Enumeration Date:
05/09/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MALEWAR
Authorized Official First Name:
SUNIL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PARAMOUNT REHABILITATION SERVICES
Authorized Official Telephone Number:
989-891-9800

Provider Taxonomy Codes

  • Taxonomy code: 2251H1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 404679870 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30738 . This is a "BLUE CROSS AND BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 30738 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 236819 . This is a "MEDICARE PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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