1427197490 NPI number — SURGICAL ASSOCIATES, PLC

Table of content: (NPI 1427197490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427197490 NPI number — SURGICAL ASSOCIATES, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ASSOCIATES, PLC
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:
1427197490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8235 HOLLY RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-2441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-694-9700
Provider Business Mailing Address Fax Number:
810-694-9940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8235 HOLLY RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-694-9700
Provider Business Practice Location Address Fax Number:
810-694-9940
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUTEKUNST
Authorized Official First Name:
CARL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-694-9700

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020B511640 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N89830 . This is a "BLUE CROSS MEDICARE ADVAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1015760 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C20472 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 105248 . This is a "PREFERRED CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C20472 . This is a "PALMETTO GBA - RR MEDICAR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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