1508347337 NPI number — CRITICAL CARE MEDICINE PARTNERS, PC

Table of content: (NPI 1508347337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508347337 NPI number — CRITICAL CARE MEDICINE PARTNERS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRITICAL CARE MEDICINE PARTNERS, 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:
1508347337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 259301
Provider Second Line Business Mailing Address:
PO BOX 67000
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-2593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-467-4150
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 FORT ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183-4698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-346-0151
Provider Business Practice Location Address Fax Number:
734-301-3325
Provider Enumeration Date:
08/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LOVE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-266-2780

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1437120185 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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