1508034141 NPI number — LOWELL MEDICAL SPECIALISTS, PC

Table of content: (NPI 1508034141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508034141 NPI number — LOWELL MEDICAL SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWELL MEDICAL SPECIALISTS, 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:
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:
1508034141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 N HUDSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49331-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-897-8436
Provider Business Mailing Address Fax Number:
616-897-5364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 N HUDSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49331-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-897-8436
Provider Business Practice Location Address Fax Number:
616-897-5364
Provider Enumeration Date:
02/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DAWSON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
616-897-8436

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301050027 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 4301063084 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 4301050027 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 4301063084 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CB8671 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 110089735 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 110D148490 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0D14849 . This is a "MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103062947 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110110939 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3088774 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4119931 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4178342 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1104119931 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1104178342 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103088774 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0D14849 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3062947 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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