1245621804 NPI number — ROCHESTER KNEE & SPORTS MEDICINE PC

Table of content: (NPI 1245621804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245621804 NPI number — ROCHESTER KNEE & SPORTS MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCHESTER KNEE & SPORTS MEDICINE 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:
1245621804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 CROSS CREEK PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
AUBURN HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48326-2774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-377-8000
Provider Business Mailing Address Fax Number:
248-377-2929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5701 BOW POINTE DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48346-3198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-377-8000
Provider Business Practice Location Address Fax Number:
248-377-2929
Provider Enumeration Date:
02/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LABELL
Authorized Official First Name:
VALERE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
248-377-8000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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