1205875697 NPI number — ELRINGTON MEDICAL CENTER PLLC

Table of content: (NPI 1205875697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205875697 NPI number — ELRINGTON MEDICAL CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELRINGTON MEDICAL CENTER 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:
1205875697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#6895 6895 RELIABLE PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60686-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-255-6500
Provider Business Mailing Address Fax Number:
313-255-3671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26611 W 7 MILE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
REDFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48240-2063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-255-6500
Provider Business Practice Location Address Fax Number:
313-255-3671
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELRINGTON
Authorized Official First Name:
ERROL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
313-255-6500

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301060303 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 4301060303 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1108253431 . This is a "BCBC BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 418911 . This is a "OMNICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7654078 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 129448 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4443670 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101675 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7691 . This is a "TOTAL HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 821912 . This is a "PROCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G34609 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 022488 . This is a "MIDWEST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 8107 . This is a "HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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