1225126782 NPI number — DR. JAMES R CREPS PT, DSCPT, OCS, CMPT

Table of content: DR. JAMES R CREPS PT, DSCPT, OCS, CMPT (NPI 1225126782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225126782 NPI number — DR. JAMES R CREPS PT, DSCPT, OCS, CMPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CREPS
Provider First Name:
JAMES
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DSCPT, OCS, CMPT
Provider Gender Code:
M

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:
1225126782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 S LANE ST
Provider Second Line Business Mailing Address:
PO BOX 162
Provider Business Mailing Address City Name:
BLISSFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49228-1243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-486-5278
Provider Business Mailing Address Fax Number:
517-486-5298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 S LANE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLISSFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49228-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-486-5278
Provider Business Practice Location Address Fax Number:
517-486-5298
Provider Enumeration Date:
10/10/2006

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:  5501002970 , 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: 5387590001 . This is a "MEDICARE DME ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 650D610700 . This is a "BCBS OF MICHIGAN INDIV ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0007902726 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104795708 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151452 . This is a "GLHP INDIV ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 141688 . This is a "PREFERRED CHOICES INDIVID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 853320223 . This is a "UNITED HEALTHCARE INDIVID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 141688 . This is a "CARE CHOICES INDIV ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 9185183 . This is a "CIGNA PPO INDIV ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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