1174253652 NPI number — OLIVE BRANCH HEALTH CARE SERVICES PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174253652 NPI number — OLIVE BRANCH HEALTH CARE SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLIVE BRANCH HEALTH CARE SERVICES PLLC
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:
1174253652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9458 LOOKOUT POINT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAINGSBURG
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48848-8783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-410-8347
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6160 SW HIGHWAY 200 STE 110-513
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34476-8307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-226-7848
Provider Business Practice Location Address Fax Number:
260-233-6054
Provider Enumeration Date:
06/16/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MEITLER
Authorized Official First Name:
STACY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-410-8347

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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