1124408943 NPI number — FAMILY CARE PRACTICE PLC

Table of content: (NPI 1124408943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124408943 NPI number — FAMILY CARE PRACTICE PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CARE PRACTICE PLC
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:
1124408943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1675 WATERTOWER PL
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
EAST LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48823-8043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-253-0539
Provider Business Mailing Address Fax Number:
517-253-0536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 WATERTOWER PL
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-8043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-253-0539
Provider Business Practice Location Address Fax Number:
517-253-0536
Provider Enumeration Date:
06/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SANFORD
Authorized Official First Name:
JON
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
517-899-1680

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5101019040 , 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: 207Q500000X . This is a "TAXONOMY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1902114424 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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