1306073945 NPI number — SAMS PHYSICAL THERAPY PC

Table of content: (NPI 1306073945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306073945 NPI number — SAMS PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMS PHYSICAL THERAPY 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:
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:
1306073945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LESLIE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49251-0158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-589-9050
Provider Business Mailing Address Fax Number:
517-589-9059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 S. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LESLIE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49251-9426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-589-9050
Provider Business Practice Location Address Fax Number:
517-589-9053
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SAMSON
Authorized Official First Name:
RANJITH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-589-9050

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  5501012063 , 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: 650C811890 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com