1265428346 NPI number — AMERICAN PROSTHETIC INSTITUTE

Table of content: (NPI 1265428346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265428346 NPI number — AMERICAN PROSTHETIC INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN PROSTHETIC INSTITUTE
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:
1265428346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2145 UNIVERSITY PARK DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48864-3982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-349-3130
Provider Business Mailing Address Fax Number:
517-349-8887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2145 UNIVERSITY PARK DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-3982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-349-3130
Provider Business Practice Location Address Fax Number:
517-349-8887
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STOKOSA
Authorized Official First Name:
JAN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
517-349-3130

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  P1109 , 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: 0C30389 . This is a "BCBS MI ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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