1215919113 NPI number — VISION INSTITUTE OF MICHIGAN SURGERY CENTER PC

Table of content: (NPI 1215919113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215919113 NPI number — VISION INSTITUTE OF MICHIGAN SURGERY CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION INSTITUTE OF MICHIGAN SURGERY CENTER PC
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:
6
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:
1215919113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44650 DELCO BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
STERLING HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48313-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-254-3391
Provider Business Mailing Address Fax Number:
586-254-3344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44650 DELCO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48313-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-254-3391
Provider Business Practice Location Address Fax Number:
586-254-3344
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RICH
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
586-254-1770

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  506819 , 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: 40360 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com