1457587016 NPI number — PHYSICIAN HEALTHCARE NETWORK-EMERGENCY MEDICINE

Table of content: TAYLOR PAIGE LUCAS LVN (NPI 1659871358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457587016 NPI number — PHYSICIAN HEALTHCARE NETWORK-EMERGENCY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN HEALTHCARE NETWORK-EMERGENCY MEDICINE
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:
1457587016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3050 COMMERCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT GRATIOT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48059-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-385-5099
Provider Business Mailing Address Fax Number:
810-385-4933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 PINE GROVE AVE
Provider Second Line Business Practice Location Address:
EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
PORT HURON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48060-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-385-5099
Provider Business Practice Location Address Fax Number:
810-385-4933
Provider Enumeration Date:
06/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KLIEMAN
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER OF FINANCIAL SERVICES
Authorized Official Telephone Number:
810-385-8082

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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