1093974917 NPI number — GEORGE C SIMPSON

Table of content: (NPI 1093974917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093974917 NPI number — GEORGE C SIMPSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE C SIMPSON
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:
1093974917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1980 E KING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORUNNA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48817-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-743-4103
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1980 E KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORUNNA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48817-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-743-4103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SIMPSON
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-743-4103

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  3501002176 , 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: 1008791 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540G810440 . This is a "MEDICARE ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0999216 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4265176 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540G81044 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540G810440 . This is a "MEPSER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540G81044 . This is a "MESSA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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