1104044783 NPI number — SOUTHFIELD OBSTETRICAL SERVICES PC

Table of content: (NPI 1104044783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104044783 NPI number — SOUTHFIELD OBSTETRICAL SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHFIELD OBSTETRICAL 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:
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:
1104044783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30400 TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
BINGHAM FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48025-5814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-353-9460
Provider Business Mailing Address Fax Number:
248-353-8084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30400 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
BINGHAM FARMS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48025-5814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-353-9460
Provider Business Practice Location Address Fax Number:
248-353-8084
Provider Enumeration Date:
04/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOCHMAN
Authorized Official First Name:
LEON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-353-9460

Provider Taxonomy Codes

  • Taxonomy code: 207VH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0F376930 . This is a "MEDICARE PLUS BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1329663 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1790780864 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 160F376930 . This is a "BCBS OF MI FEDERAL EMPLOY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4461641 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160F376930 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4461632 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4620480 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160F376930 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 9041407 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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