1497968754 NPI number — MYMICHIGAN MEDICAL CENTER ALPENA

Table of content: SCOTT MICHAEL VANCURA DPT (NPI 1730474065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497968754 NPI number — MYMICHIGAN MEDICAL CENTER ALPENA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYMICHIGAN MEDICAL CENTER ALPENA
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:
1497968754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 WELLNESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48670-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-356-7390
Provider Business Mailing Address Fax Number:
989-356-8013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 W CHISHOLM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPENA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-356-7390
Provider Business Practice Location Address Fax Number:
989-356-8013
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHERWIN
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-356-7390

Provider Taxonomy Codes

  • Taxonomy code: 276400000X , with the licence number:  040010 , 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: 20105 . This is a "BCBS SUBSTANCE ABUSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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