1518203231 NPI number — MRS. ANCY MATHAI VARGHESE OTR

Table of content: MRS. ANCY MATHAI VARGHESE OTR (NPI 1518203231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518203231 NPI number — MRS. ANCY MATHAI VARGHESE OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGHESE
Provider First Name:
ANCY
Provider Middle Name:
MATHAI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

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:
1518203231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48337 AMERICAN ELM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACOMB
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48044-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-933-2111
Provider Business Mailing Address Fax Number:
586-933-2111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 N HURSTBOURNE PKWY
Provider Second Line Business Practice Location Address:
PARAGON REHABILITATION
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-5185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-412-5847
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  5201004010 , 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)