1437227923 NPI number — NORTH POINT MEDICAL CENTER PC

Table of content: (NPI 1437227923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437227923 NPI number — NORTH POINT MEDICAL CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH POINT MEDICAL CENTER 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:
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:
1437227923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48004-0327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-725-9611
Provider Business Mailing Address Fax Number:
586-725-2630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9838 DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48023-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-725-9611
Provider Business Practice Location Address Fax Number:
586-725-2630
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GROSS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-725-9611

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5101007067 , 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: 1097101 TYPE 11 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: G7223 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A-663-77 . This is a "LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 5101007067 . This is a "LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: E39807 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0857400645 . This is a "BCBS PROVIDER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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