1154447464 NPI number — PETER R PASHLEY D.O.,P.C

Table of content: (NPI 1154447464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154447464 NPI number — PETER R PASHLEY D.O.,P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER R PASHLEY D.O.,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:
1154447464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38300 VAN DYKE AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
STERLING HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48312-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-446-7870
Provider Business Mailing Address Fax Number:
586-446-7871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38300 VAN DYKE AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48312-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-446-7870
Provider Business Practice Location Address Fax Number:
586-446-7871
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PASHLEY
Authorized Official First Name:
PETER
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
586-446-7870

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  5101013427 , 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: 1157410875 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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