1306003538 NPI number — GREENWOOD PEDIATRICS

Table of content: (NPI 1306003538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306003538 NPI number — GREENWOOD PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWOOD PEDIATRICS
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:
1306003538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 W FRANKLIN ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49201-1674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-784-9104
Provider Business Mailing Address Fax Number:
517-784-9107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 W FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49201-1674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-784-9104
Provider Business Practice Location Address Fax Number:
517-784-9107
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUMAYUN
Authorized Official First Name:
NASEER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-784-9104

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  NH033036 , 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: 102196 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5192038 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 8503811891 . This is a "BLUE CARE NETORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 8503811891 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1220021 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900039729 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com