1083705024 NPI number — MEDICS PC

Table of content: (NPI 1083705024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083705024 NPI number — MEDICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICS 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:
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:
1083705024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 529
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMORE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48829-0529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-427-5070
Provider Business Mailing Address Fax Number:
989-427-3690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1131 E M-46
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMORE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48829-0529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-427-5070
Provider Business Practice Location Address Fax Number:
989-427-3690
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REAMES
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
989-427-5070

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 70-0-E9-6344-0 . This is a "BCBSM GROUP ID #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com