1295765071 NPI number — RENAL CENTER PHYSICIANS

Table of content: MEAGAN ELIZABETH BARROW PMHNP (NPI 1356867279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295765071 NPI number — RENAL CENTER PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAL CENTER PHYSICIANS
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:
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:
1295765071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22201 MOROSS RD STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-2152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-247-4300
Provider Business Mailing Address Fax Number:
586-532-6496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2607 ELECTRIC AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HURON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48060-6587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-987-5252
Provider Business Practice Location Address Fax Number:
810-987-2120
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUTHUSWAMI
Authorized Official First Name:
SUBBANA
Authorized Official Middle Name:
GOUNDER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-987-5252

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102570422 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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