1265635593 NPI number — HURON GASTROENTEROLOGY ASSOCIATES PC

Table of content: (NPI 1265635593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265635593 NPI number — HURON GASTROENTEROLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HURON GASTROENTEROLOGY ASSOCIATES 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:
1265635593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 ELLIOTT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-8632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-434-6262
Provider Business Mailing Address Fax Number:
734-712-2820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 BYRON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48843-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-434-6262
Provider Business Practice Location Address Fax Number:
734-712-2820
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
LANA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
734-528-1405

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CE4308 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 10H14989 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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