1174604243 NPI number — MRS. JILL MARIE HRABINSKY PT

Table of content: MRS. JILL MARIE HRABINSKY PT (NPI 1174604243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174604243 NPI number — MRS. JILL MARIE HRABINSKY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HRABINSKY
Provider First Name:
JILL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAKLE
Provider Other First Name:
JILL
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174604243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49253 HWY M26
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANCOCK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-483-0798
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56901 S 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
CALUMET
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49913-2946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-337-1100
Provider Business Practice Location Address Fax Number:
906-337-3869
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501006289 , 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: 650C157010 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DD6320 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10 4565600 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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