1164627782 NPI number — ASPEN URGENT CARE, LTD.

Table of content: (NPI 1164627782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164627782 NPI number — ASPEN URGENT CARE, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPEN URGENT CARE, LTD.
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:
1164627782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7581 SECOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAMBERTVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48144-9624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-854-1800
Provider Business Mailing Address Fax Number:
734-856-6364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7581 SECOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMBERTVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48144-9624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-854-1800
Provider Business Practice Location Address Fax Number:
734-856-6364
Provider Enumeration Date:
06/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEYTON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
73348541800

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2590101 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080E811050 . This is a "MICHIGAN BCBS/BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1164627782 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04855 . This is a "PARAMOUNT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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