1326178732 NPI number — MRS. MARIE LOUISE MERKX-QUINN PT, OCS, CERT MDT

Table of content: MRS. MARIE LOUISE MERKX-QUINN PT, OCS, CERT MDT (NPI 1326178732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326178732 NPI number — MRS. MARIE LOUISE MERKX-QUINN PT, OCS, CERT MDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERKX-QUINN
Provider First Name:
MARIE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, OCS, CERT MDT
Provider Gender Code:
F

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:
1326178732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 RAYBROOK ST SE
Provider Second Line Business Mailing Address:
SUITE #304
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-7717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-464-3580
Provider Business Mailing Address Fax Number:
616-464-3581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 RAYBROOK ST SE
Provider Second Line Business Practice Location Address:
SUITE #304
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-7717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-464-3580
Provider Business Practice Location Address Fax Number:
616-464-3581
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  L736622 , 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: 0D15723 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 650D157230 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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