1134301484 NPI number — MARK E GINTHER M D P C

Table of content: (NPI 1134301484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134301484 NPI number — MARK E GINTHER M D P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK E GINTHER M D P C
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:
1134301484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 S WENONA ST
Provider Second Line Business Mailing Address:
SUITE 225
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48706-8820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-893-9705
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S WENONA ST
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48706-8820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-893-9705
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GINTHER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-893-9705

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301405779 , 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: 110090143 . This is a "BCBSM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110210595 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19380 . This is a "COMMUNITY CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110090143 . This is a "FEP BCBSM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4115699 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0090143 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0990164 . This is a "HEALTH PLUS OF MI" identifier . This identifiers is of the category "OTHER".




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