1346295730 NPI number — VWC, PLLC

Table of content: (NPI 1346295730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346295730 NPI number — VWC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VWC, PLLC
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:
1346295730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5773 N CANTON CENTER RD
Provider Second Line Business Mailing Address:
STUIT 5
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48187-2620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-981-1950
Provider Business Mailing Address Fax Number:
734-498-1198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5773 N CANTON CENTER RD
Provider Second Line Business Practice Location Address:
STUIT 5
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48187-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-981-1950
Provider Business Practice Location Address Fax Number:
734-498-1198
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIEBER
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-981-1950

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301009126 , 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: 0H22922 . This is a "BCBSM" identifier . This identifiers is of the category "OTHER".




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