1104152214 NPI number — NEWAYS INTEGRATED WELLNESS CENTER

Table of content: ANDREW MICHAELS PH.D. (NPI 1649423195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104152214 NPI number — NEWAYS INTEGRATED WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWAYS INTEGRATED WELLNESS CENTER
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:
1104152214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 503010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97503-0813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-941-7792
Provider Business Mailing Address Fax Number:
503-419-4662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
385 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-973-9673
Provider Business Practice Location Address Fax Number:
888-763-5973
Provider Enumeration Date:
10/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARY
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
CATHERINE
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
541-941-9246

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  C1762 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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